Transforming Plastic and Reconstructive Surgical Care in Low- and Middle-Income Countries: A Paradigm Shift to the Diagonal Model.

SUMMARY: The article highlights the global lack of access to basic surgical services, particularly in low- and middle-income countries (LMICs), where only 3.5% of surgical procedures serve 34.8% of the population. Plastic and reconstructive surgery, constituting 16% of treatable conditions, is a significant unmet need. Surgical outreach, popular for burns, trauma, and cleft lip, is addressed by organizations like ReSurge, Smile Train, and Operation Smile. The shift from the traditional "vertical model" to a "diagonal model" prioritizes long-term relationships, capacity-building, and sustainable healthcare. Efforts include education through programs like the ReSurge Global Training Program, a blended learning approach, and technology integration for ongoing support. The diagonal model aims to address not just immediate patient needs but also systemic challenges, emphasizing collaboration and empowerment for sustainable healthcare outcomes.

Postmastectomy Functional Impairments.

PURPOSE OF REVIEW: This narrative review aims to offer a thorough summary of functional impairments commonly encountered by breast cancer survivors following mastectomy. Its objective is to discuss the factors influencing these impairments and explore diverse strategies for managing them. RECENT FINDINGS: Postmastectomy functional impairments can be grouped into three categories: neuromuscular, musculoskeletal, and lymphovascular. Neuromuscular issues include postmastectomy pain syndrome (PMPS) and phantom breast syndrome (PBS). Musculoskeletal problems encompass myofascial pain syndrome and adhesive capsulitis. Lymphovascular dysfunctions include lymphedema and axillary web syndrome (AWS). Factors such as age, surgical techniques, and adjuvant therapies influence the development of these functional impairments. Managing functional impairments requires a comprehensive approach involving physical therapy, pharmacologic therapy, exercise, and surgical treatment when indicated. It is important to identify the risk factors associated with these conditions to tailor interventions accordingly. The impact of breast reconstruction on these impairments remains uncertain, with mixed results reported in the literature.