Mapping Plastic Reconstructive Surgical Needs and Access Barriers in Sub-Saharan Africa: A Scoping Review.

BACKGROUND

An estimated 140 million additional surgical procedures are required annually, yet access to safe, timely, and affordable surgical care remains limited, particularly in low- and middle-income countries, where the poorest 2.2 billion people receive only 3.5% of procedures. In sub-Saharan Africa, the burden of trauma, burns, and congenital malformations far exceeds available capacity, yet evidence on plastic reconstructive surgery (PRS) remains fragmented and poorly quantified. This scoping review mapped the current state of PRS evidence, disease burden, and barriers to care in the region.

METHODS

We conducted comprehensive search of PubMed, Embase, and Web of Science, Bioline International, and AJOL (Oct 21, 2024) supplemented by gray-literature screening. Studies addressing PRS-relevant pathologies, surgical capacity, or barriers to care in sub-Saharan Africa (excluding South Africa) were included without date or language restriction. Data were charted in Covidence and synthesized descriptively.

RESULTS

Of 11,780 records, 353 met inclusion criteria. Trauma (43.6%) and burns (40.2%) dominated reconstructive workload, with congenital anomalies reported in 33.4% of studies. Most research originated from Nigeria, Uganda, and Tanzania and was concentrated in tertiary hospitals. Workforce shortages, inadequate infrastructure, and financial barriers were the most frequent obstacles. Skin grafting and wound management comprised over one-third of reported procedures. PRS interventions were highly cost-effective, with estimates as low as US$33 per DALY averted.

CONCLUSIONS

Reconstructive surgery in sub-Saharan Africa remains critically under-researched and under-resourced. Addressing inequities requires locally adapted assessment tools, workforce expansion, and integration of PRS into national surgical plans.