Pioneering Microsurgery Services in Low-income Countries: Insights from a Plastic Surgeon's Experience in Ethiopia.

Background: Microsurgery, a revolutionary tool in reconstructive procedures, has historically faced challenges in implementation within resource-limited settings. This article presents the journey of establishing microsurgery services at Jimma University Medical Center (JUMC) in Ethiopia, a nation where a significant portion of the population lacks access to microsurgery. The objective was to provide a guide for establishing a microsurgery center in resource-limited settings and share experiences, challenges, and successes encountered during the establishment of the microsurgery unit at JUMC. Methods: The methodology involved a needs assessment, collaboration with Operation Smile, training and capacity building, team and system building, and infrastructure and equipment setup. Strategies included identifying the demand for microsurgery services, collaborating with Operation Smile for resource acquisition, conducting training initiatives in India, and forming a multidisciplinary team. Results: The article introduces the initial series of free flap procedures conducted at JUMC, marking a significant milestone in the region's surgical capabilities. Cases include forearm dermatofibrosarcoma protuberans, postburn exposed calcaneal bone, and buccal squamous cell carcinoma, demonstrating the diversity and complexity of cases that necessitate microsurgical intervention. Conclusions: The journey of establishing microsurgery services at JUMC represents a significant milestone. Lessons learned provide valuable insights for other centers in developing countries aiming to initiate or enhance their microsurgery programs. Recommendations include continuous training, expanding collaborative networks, advocating for sustainable resource allocation, research and outcome monitoring, incorporating microsurgery into formal curricula, and adapting protocols based on local realities. Implementing these recommendations can contribute to the growth and sustainability of microsurgery initiatives in resource-limited settings.