The Role of International Fellowships in Expanding Reconstructive Surgery Capacity in Sub-Saharan Africa: Training the Trainer

BACKGROUND: The burden of conditions treated by microsurgeons in Sub-Saharan Africa is high and is exacerbated by a paucity of local, subspecialty-trained reconstructive surgeons. This study describes a learner-driven, collaborative approach to creating a microsurgical training pipeline. METHODS: We identified junior plastic surgeons interested in microsurgery training from College of Surgeons of East, Central, and Southern Africa (COSECSA)-affiliated countries where Operation Smile actively supports surgical care delivery. Candidates completed a needs assessment survey to inform the development of a context-appropriate microsurgery curriculum hosted by Chang Gung Memorial Hospital with waived fees for teaching, instruction, and dormitory stay, and additional scholarship funding by Operation Smile. Hospital assessments completed by Operation Smile were reviewed to identify investment targets at fellows’ home health systems. RESULTS: We received 13 applications from candidates in five COSESCA-affiliated countries. Needs assessments informed a role for initial lab-based technical training and a tailored curriculum emphasizing the use of workhorse flaps for select microsurgery indications. Hospital assessments identified opportunities for investment in infrastructure, multidisciplinary team training, and longitudinal training models for ongoing support. CONCLUSION: This study describes the development of a microsurgical training pipeline for surgeons in Sub-Saharan Africa and the role that non-governmental organizations and international centers of excellence play in expanding surgical capacity abroad. Future directions include evaluating the long-term impact of training and the feasibility of creating local microsurgery centers through multidisciplinary training and longitudinal support.