Scarborough Hospital surgeons perform first microvascular free tissue transfers in Bolivia

Two of The Scarborough Hospital’s plastic surgeons have done it again – performing microsurgical ‘firsts’ in their work in the Third World.

Drs. Tim Sproule and Sarah Wong travelled to La Paz, in March, where they set up the first course using live animal dissections ever attempted in the developing world. La Paz – at an altitude of approximately 4,000 meters – is the highest capital city in the world, and there is speculation that the free flap surgeries they performed may be the first such surgeries in history at such a high altitude. But what is definite is that Drs. Sproule and Wong performed the first microvascular free tissue transfers in Bolivia.

“We’re thinking of collaborating on a paper for medical journals, since there are physiological changes that occur in the local population that make this type of microsurgery especially challenging,” Dr. Sproule explains.

Those physiological changes come in two forms: elevated haemoglobin production to increase oxygen carrying capacity; and increased blood viscosity. This means the blood is thicker, and runs through the tissue less readily, increasing the potential to clot.

“The technical aspect of doing this kind of procedure anywhere is very challenging, but in La Paz, we were doing microsurgery on tiny veins and we weren’t sure what the effect the high altitude would have on the surgery,” Dr. Sproule says. “Local surgeons told us there are two choices: bleed the patients ahead of time to temporarily dilute the blood, or use heparin. We decided to use a low dose of continuous heparin infusion.”

The two clinical cases – a woman with a severe forearm injury from a car accident and an old gunshot wound to the face of a young man – were considered successes. Muscle was removed from the woman’s stomach to repair the lost muscle tissue in her forearm. And a piece of the man’s fibula was removed from his leg which, along with a titanium reconstruction plate, were shaped to replace the missing piece of his jaw.

“This trip was 110 per cent successful,” says Dr. Wong. “Not only did we conduct a course with six graduates and train surgeons to do microsurgery, we actually did the surgery on two patients.

“Dr. Sproule and I showed that this can be done successfully in a country where it had never been done before.”

This was the second trip to Bolivia for Drs. Sproule and Wong, and it likely won’t be their last.

“This is ongoing, and we’re excited about going back and doing more free flaps,” Dr. Sproule adds. “What empowered me to do this is contemplating a patient having their hand or finger chopped off, and that appendage is in the garbage because no one in Bolivia had the capacity to do microsurgery, which is routine here. Now, they have the training to do it themselves.”

Their trip was co-sponsored by Resurge International and Canadian Reconstructive Surgery Foundation, founded by Dr. Sproule. In addition to volunteering their expertise to train and perform the two surgeries, Dr. Sproule also donated sutures and equipment to be used by the local medical staff.