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The article examines ethical considerations when providing these services in LMIC contexts, integrating views from local and visiting surgeons and from a holistic global surgery perspective. It grounds the discussion in the core principles of clinical ethics: autonomy, beneficence, non-maleficence, and justice, which structure the paper’s analysis.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/ethical-considerations-of-complex-reconstructions-in-resource-poor-countries/434386/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/ethical-considerations-of-complex-reconstructions-in-resource-poor-countries/434386.png","ImageObject",300,407,{"name":92,"@type":93},"Jordan Avery","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"为什么需要在低中收入国家提供复杂重建手术？","Question",{"text":112,"@type":113},"文章指出LMICs存在普遍的创伤与疾病负担，同时医疗基础设施与资源条件有限，因此复杂重建手术的需求持续存在。","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"文章如何界定讨论所依循的临床伦理基础？",{"text":117,"@type":113},"论文以临床伦理四项基本原则为结构：自主（autonomy）、行善（beneficence）、不伤害（non-maleficence）与正义（justice）。",{"name":119,"@type":110,"acceptedAnswer":120},"文章从哪些视角讨论在LMICs提供复杂重建服务的伦理问题？",{"text":121,"@type":113},"讨论涵盖本地与外来（访问）外科医生的视角，并进一步纳入整体性的全球外科（global surgery）视角。","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},434386,1790890709,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},1099523882367,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","JPRAS Open 47 (2025) 43–50  \nContents lists available at ScienceDirect  \nJPRAS Open  \njournal [homepage:](homepage: www.elsevier.com/locate/jpra)[ www.elsevier.com/locate/jpra](homepage: www.elsevier.com/locate/jpra)  \n| Original Article\u003Cbr>Ethical considerations of complex\u003Cbr>reconstructions in resource poor countries\u003Cbr>Oluwakemi Ayoadea, Abdulrasheed Ibrahim b,\u003Cbr>Chihena H. Bandac,d, Wee Lame,f, Barbara Jemecf,g,∗\u003Cbr>a Department of Plastic and Reconstructive Srgery, National Orthopaedic Hospital, 12/124 Ikorodu Road, Igbobi, Lagos 102216, Nigeria\u003Cbr>b Division of Burns and Plastic surgery, Ahmadu Bello University & Ahmadu Bello University Teaching Hospital Zaria, Sokoto Road Zaria, Kaduna State, Nigeria\u003Cbr>c Plastic and Reconstructive Surgery Unit, Department of Surgery, The University Teaching Hospital, Nationalist Road, Lusaka, Zambia\u003Cbr>d Department of Surgery, School of Medicine, University of Zambia, Ridgeway Campus, Nationalist Road, Lusaka, Zambia\u003Cbr>e Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Third Hospital Avenue, Singapore 168753, Singapore\u003Cbr>f British Foundation for International Reconstructive Surgery and Training, c/o BAPRAS, Royal College of Surgeons of England, 38-43 Lincoln’s Inn Fields, London WC2A 3PE, London, England\u003Cbr>g Department of Plastic Surgery, Queensway Carleton Hospital, 3045 Baseline Road, Ottawa, ON K2H 8P4 |  |  |\n| --- | --- | --- |\n| a r t i c l e i n f o |  | a b s t r a c t |\n| Article history:\u003Cbr>Received 30 August 2025\u003Cbr>Accepted 2 September 2025\u003Cbr>Available online 6 September 2025 |  | There is a need for complex plastic surgery reconstructive work in low-and middle-income countries (LMICs). This paper will discuss the ethical considerations when offering this service in LMICs, from the local and the visiting surgeon’s perspective, their patients anda holistic global surgery perspective. The basic principles of clinical ethics are autonomy, beneficence, non-maleficence and justice, and are the foundation for the structure of this paper.\u003Cbr>© 2025 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license\u003Cbr>([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) |\n| Keywords:\u003Cbr>Global surgery\u003Cbr>Complex reconstruction\u003Cbr>Ethics\u003Cbr>Autonomy\u003Cbr>Beneficence\u003Cbr>Non-maleficence\u003Cbr>Justice |  |  |\n\n∗ Corresponding author.  \nE-mail [address:](address: bjemec@qch.on.ca)[ bjemec@qch.on.ca](address: bjemec@qch.on.ca) (B. Jemec) .  \n[https://doi.org/10.1016/j.jpra.2025.09.002](https://doi.org/10.1016/j.jpra.2025.09.002)  \n2352-5878/© 2025 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license  \n([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/))  \nO. Ayoade, A. Ibrahim, C.H. Banda et al. JPRAS Open 47 (2025) 43–50  \nIntroduction  \nPlastic surgery has undergone a significant paradigm shift in recent decades. While the reconstructive ladder was once seen to be the standard algorithm for deciding reconstructive strategies, the advent of microsurgery and various flap options have allowed surgeons to perform more complex reconstructive options to achieve the best results. Consequently, more complex options, e.g., microsurgery, are often preferred to achieve a one stage reconstruction with minimal donor morbidity while optimizing the functional and aesthetic results.  \nSuch complex reconstructions often require more extensive resources. These include more sophisticated instruments, but also manpower for postoperative care. Furthermore, the skillsets required involve years of specialist training in high volume centers, or sponsored fellowships; resources which may only be available in high income countries (HICs). Vi","cbCaiiQJ9HOO7gHx","https://ap.wps.com/l/cbCaiiQJ9HOO7gHx","pdf",330363,"English","# Introduction\n## The need for complex reconstructions in LMICs\n## Ethical principles guiding clinical decision-making","[{\"question\":\"为什么需要在低中收入国家提供复杂重建手术？\",\"answer\":\"文章指出LMICs存在普遍的创伤与疾病负担，同时医疗基础设施与资源条件有限，因此复杂重建手术的需求持续存在。\"},{\"question\":\"文章如何界定讨论所依循的临床伦理基础？\",\"answer\":\"论文以临床伦理四项基本原则为结构：自主（autonomy）、行善（beneficence）、不伤害（non-maleficence）与正义（justice）。\"},{\"question\":\"文章从哪些视角讨论在LMICs提供复杂重建服务的伦理问题？\",\"answer\":\"讨论涵盖本地与外来（访问）外科医生的视角，并进一步纳入整体性的全球外科（global surgery）视角。\"}]","Ethical considerations of complex reconstructions in resource poor countries | PDF",1790668985]