Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 16  |  Issue : 1  |  Page : 1-8

Plastic surgery in Nigeria: our yesterday, today and tomorrow


Division of Plastic & Reconstructive Surgery, Department of Surgery, College of Health Sciences, University of Jos/Jos University Teaching Hospital, Jos, Nigeria

Date of Submission06-May-2020
Date of Acceptance29-Jun-2020
Date of Web Publication17-Sep-2020

Correspondence Address:
Professor Simon Jekat Yiltok
Department of Surgery, College of Health Sciences, Lamingo Campus, University of Jos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njps.njps_10_20

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  Abstract 

The Nigerian Association of Plastic, Reconstructive and Aesthetic Surgeons (NAPRAS) instituted a lecture in honor of the doyen of Plastic Surgery in Nigeria, Professor Joseph Olatunde Oluwasanmi. A man who took up the challenge to specialize in plastic surgery thus becoming the first indigenous consultant plastic surgeon in 1967. He rose through the ranks to become a professor in 1973. The 2017 annual conference of the association took place in Sokoto and the lecture focused on the history and practice of plastic surgery in Nigeria. The lecture chronicled those who practice plastic surgery in Nigeria beginning from Mr Michael Norbert Tempest, a British Surgeon who worked in University College Hospital (UCH), Ibadan as a consultant, while Mr J.O. Oluwasanmi (now Prof J.O. Oluwasanmi) worked under him as a Senior Registrar. Oluwasanmi was later appointed as the first indigenous Consultant Plastic Surgeon in1967 after returning from the UK where we went for his specialty training in plastic surgery. Many other centers sprang up providing plastic surgery services. These centers include Lagos University Teaching Hospital, Lagos; National Orthopedic Hospital, Igbobi Lagos; National Orthopedic Hospital, Enugu; Ahmadu Bello University Teaching Hospital, Kaduna; Mangu Rehabilitation Centre, Mangu Plateau State and ECWA Evangel Hospital Jos (now Bingham University Teaching Hospital). Most of these centers have continued to provide plastic surgery services and training while several others have joined the train. Plastic surgery is now well established in Nigeria, however there are still challenges that affect the provision of excellent service. These challenges include; inadequate personnel, lack of awareness of the practice of plastic surgery, limited infrastructure, poverty and lack of universal health coverage, cultural practices and believes, patients’ expectations, complications, complexity of cases and workload.

Keywords: Challenges, history of practice, Nigeria, Oluwasanmi, plastic surgery


How to cite this article:
Yiltok SJ. Plastic surgery in Nigeria: our yesterday, today and tomorrow. Nigerian J Plast Surg 2020;16:1-8

How to cite this URL:
Yiltok SJ. Plastic surgery in Nigeria: our yesterday, today and tomorrow. Nigerian J Plast Surg [serial online] 2020 [cited 2020 Nov 1];16:1-8. Available from: https://www.njps.org/text.asp?2020/16/1/1/295253


  Introduction Top


Distinguished colleagues and our honored guests, it is a great honor for me to deliver this year’s Presidential lecture instituted by the Nigerian Association of Plastic, Reconstructive and Aesthetic Surgeons (NAPRAS) in honor of the doyen of Plastic Surgery in Nigeria, Professor Joseph Olatunde Oluwasanmi [Figure 1]. A man who took up the challenge to specialize in plastic surgery thus becoming the first indigenous Consultant plastic surgeon in 1967. He rose through the ranks to become a professor in 1973.
Figure 1 Professor Joseph O. Oluwasanmi

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My first encounter (if indeed is really an encounter) with him was an indirect one, through his textbook titled, Plastic Surgery in the Tropics: an introduction for medical students and surgeons [Figure 2][1] which I found in our secondary school library in 1982 or 1983. The content of the book did not make sense to me then. I was just curious to know what plastic surgery means but with cosmetic (aesthetic surgery) in my mind. I wonder why the school authority bought and stock this book for a secondary school library, where the students are more interested in getting good grades in the basic sciences (biology, chemistry, physics, mathematics and additional mathematics) for their GCE O’ Level. I also came across this same book in our library as a medical student. As a medical student I did not bother about it, probably because we had no plastic surgeon then amongst our lecturers to arouse my interest in that field. Generally, we were more concerned about graduating first and to bother about specialization thereafter.
Figure 2 Oluwasanmi, JO. Plastic Surgery in the Tropics: an introduction for medical students and surgeons[1]

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My second encounter with Prof Oluwasanmi was in September 1997 when he visited the Jos University Teaching Hospital where he gave a talk on wounds and in that visit, he came along with copies of another book he had written on wounds and wound healing [Figure 3].[2] I was then a Senior Registrar and Chief Resident in Surgery who has decided to specialize in Plastic Surgery following the footstep of my boss Dr Kusu S. Orkar. Prof Oluwasanmi did encourage me to pursue that dream and with the reinforcement from Prof Sowemimo under whom Dr Orkar trained I commenced my training the following year. My third encounter was three years ago, at the 20th annual meeting of NAPRAS that held in Abuja during my tenure as President of the Association in August 2014. I want to believe that my encounter with Prof Oluwasanmi’s textbook must have had a subtle influence on me in my choice to specialize as a plastic surgeon. It should be noted that my classmates in medical school had no doubt that I will end up as a surgeon right from our pre-clinical days, as I was called then ‘Surgeon General’ because I was the lead dissector in our anatomy dissection group.
Figure 3 Oluwasanmi, JO. Wounds and wound healing. Akure: Joe-Jane Medical Centre[2]

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  Plastic surgery Top


Plastic surgery began thousands of years ago, when surgeons in India reconstructed nose by transferring flap from the cheek and then forehead skin.[3] The specialty has grown over time in scope and complexity. The word plastic originate from the Greek word ‘plastikos’ meaning to mold and reshape, is a specialty that adopts surgical principles to address the unique needs of individual patient.[3] It can be best described as a specialty that is devoted to solving complex wound healing and surgical problems with a goal being the restoration or creation of the best function, form and structure of the body with a superior aesthetic appearance which ultimately improves the patient quality of life. As outlined by the American Board of Plastic Surgery, the specialty deals with the repair, replacement and reconstruction of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk, external genitalia etc.[3] It uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. The Plastic Surgeon focuses on treating the individual and not just focusing on the lesion or pathology. Irrespective of the pathology the focus is the effect of the outcome on the entire patient. The plastic surgeon is not limited to a set of condition or procedures but must deal with so many specialists in the field of medicine to help bring succor to many. The plastic surgeon often acts as the ‘last resort’ surgical consultant to surgeons and physicians in the treatment of many wound problem and is often called ‘the surgeon’s surgeon’.[3]

In Nigeria, the specialty has come a long way with a checkered history that dates back to the post independent era, beginning with expatriate surgeons. It started with just an institution which is the premier teaching hospital in Nigeria, the University College Hospital Ibadan (with Mr Michael Norbert Tempest, a British Surgeon) but now we have several teaching, specialist and Federal Medical Centers and some private health facilities providing such specialized services. The services range from simple procedures to more complex plastic surgeries that are carried out either by plastic surgeons alone or in collaboration with other surgeons of other specialties.


  Our yesterday Top


In the early stage of practice of plastic surgery in Nigeria the main base was in the southern part of the country beginning with the University College Hospital (UCH), Ibadan with Mr Tempest who was a Consultant, while Mr J.O. Oluwasanmi (now Prof J.O. Oluwasanmi) worked under him as a Senior Registrar. He was later appointed as the first indigenous Consultant Plastic Surgeon in1967 after returning from the UK where we went for his specialty training in plastic surgery. Prof J.O. Oluwasanmi was later joined by Prof F.A. Ofodile who had his training in the US, they later left the services of the University and the hospital. Dr Chika Ogbonna who had his training in Europe joined the UCH, Ibadan around 1980 but later left to become a Consultant with the State Hospital, Adeoyo Ibadan. The hospital remained without the services of a plastic surgeon for about a decade until Dr O.M. Oluwatosin (now Prof O.M. Oluwatosin) was appointed. This led to the training of several plastic surgeons, the early ones were Dr J.A. Bolajoko, Dr J.K. Olabanji (now Prof Olabanji), Dr S.A. Ademola, Dr F.O. Abikoye, Dr I.A. Adigun (now Prof Lawal), Dr C. Tahir (now Prof Tahir), Dr A.O. Olawoye, Dr T. Gana amongst others. Dr Aderoju returned from 1980 to the University of Ife Teaching Hospital Complex {now Obafemi Awolowo University Teaching Hospital Complex (OAUTHC)}, but he left there shortly to the State Hospital Adeoyo, Ibadan and later became a Director in the Ministry of Health before retiring.

In Lagos, Prof S.A. Ademiluyi, Prof G.O. Sowemimo, Dr J.O. Oyeneyin were in the services of the University of Lagos and Lagos University Teaching Hospital (LUTH) as lecturers and plastic surgeons. Prof Ademiluyi left the services to work abroad at the period of brain drain in the ‘80s but later join the Lagos State University Teaching Hospital (LASUTH) on his return but he is now retired. Prof Sowemimo and Dr Oyeneyin continued and retired from the same institution. From LUTH, several plastic surgeons were trained by them, some of them are Dr I.O. Fadeyibi, Dr Muna K. Chira, Dr A.O. Ugburo, Dr K.S. Orkar, Dr B.O. Mofikoya, Dr D. Ibikuaje, Dr T.A. Atuk amongst others. The National Orthopedic Hospital, Igbobi Lagos had the services of Dr Segun Aranmolate who pioneered plastic surgery services in that hospital and he was later joined by Dr Muna K. Chira who is still in the services of the hospital.

In the ‘70s after the Nigerian civil war the East Central State Government established a hospital to help in the policy of reconciliation, reconstruction and rehabilitation.[4] The hospital was to handle orthopedic, plastic and ophthalmic conditions. The ophthalmic component was moved to Kaduna when the Federal Government took over the hospital. The first plastic surgeon that was appointed was Dr J.C. Nwozo who was joined later by Dr L.M. Iregbulem. Dr F.C. Akpuaka (now Prof Akpuaka) who joined the services of the hospital and later left for further training in plastic surgery in the UK and on completion of his studies he returned to work in the same hospital and was later appointed a Consultant Plastic Surgeon. He was later joined by Dr B.O. Uchendu who later rose to the rank of a Consultant. Dr I. D. M. Onyia also joined the hospital but later left to start a private practice. Dr J.U. Achebe became the first person to be certified by West African College of Surgeons having trained in the hospital (he spent one year overseas training in Britain).[4] Subsequently several plastic surgeons were trained from the National Orthopedic Hospital Enugu. The early ones include Dr E.E.C. Echezona, Dr R.E.E. Nnabuko, Dr B.C. Jiburum, Dr (Mrs) Onyeador, Dr E. Onyenyirionwu, Dr I.S. Ogbonnaya, Dr I.I. Onah amongst others. Professor D.D. Brown provided plastic surgery services in Port Harcourt working with the University of Port Harcourt and the University of Port Harcourt Teaching Hospital (UPTH).

In the northern part of the country plastic surgery services in Jos and Kaduna axis were provided by expatriates who had their training in the US, Britain and the Netherlands. The surgeons were Dr L.L. Carter Jnr in Jos, Dr C.A. Spronk in Mangu, Prof Rasamay Ganguly (a retired Brigadier in the Indian Army)[5] in Kaduna. Drs Carter Jnr and Spronk were working in Christian missionary hospital Plateau State. Dr Carter Jnr in addition to clinical practice in ECWA Evangel Hospital Jos (now Bingham University Teaching Hospital) also served as an associate lecturer in surgery with the University of Jos. They all provided a wide range of plastic surgery that provided succor to many patients. Their waiting list was up to a year because of the vast region they cover. Prof Ganguly who was British trained arrived Kaduna in 1981 and served as a Professor in ABU for 18 years, operating up to the age of 80 years before finally retiring back to his country and died 2 years later. Prof Ganguly came with a rich history in military service, excellent surgeon and trainer of surgeons. He pioneered the practice and training in plastic surgery in Pune India. One of us had part of his training with him Dr M.E. Asuku (now Professor Asuku) who is now based in the US. Prof Asuku trained others like Dr H. Rabe, Dr A. Ibrahim and Dr F. Ijekeye. On the other hand, Dr K.S. Orkar returned to Jos after his training to establish the plastic surgery unit in the Jos University Teaching Hospital and subsequently trained Dr S.J. Yiltok (now Prof S.J. Yiltok), Dr J.N. Legbo (now Prof J.N. Legbo) and Dr A. Jenrola. Many more plastic surgeons have been trained and continued to be trained. There could have been some other plastic surgeons that provided plastic surgery services within this early period but could not be located or remain unknown. This is more so that there were several leprosy hospitals or centres run by missionaries that provide reconstructive surgery for leprosy, usually by expatriates.

In the early stage of plastic surgery practice in the country, most if not all the practitioners had their training abroad. These were accomplished plastic surgeons who made their mark both within and outside the country. Prof Oluwasanmi the doyen of plastic surgery in Nigeria pioneered the practice of plastic and maxillofacial surgery in Nigeria as an indigenous surgeon. His practice of maxillofacial surgery pre-dated the establishment of the maxillofacial surgery department and indeed dentistry in the University College Hospital and University of Ibadan. He rose to the rank to the rank of a Professor and became the head of surgery before retiring. He had over 45 peer-reviewed articles that are indexed between 1968 and 1980. This was a rare feat in those days considering the workload, the limited number of available journals, long period of peer review and long editorial process. Prof Sowemimo was active in the West African College of Surgeon and served at one time the Secretary General of the College. He was the former Provost of the College of Medicine University of Lagos and a recipient of the National honor of Guinea Conakry. The American Burn Society gave him an award to give the 1993 Everett Idris Evans Memorial Lecture, in Cincinnati, Ohio USA.[6] He is currently serving as the Chairman Board of Trustees of the Kings University in Odeomu, Osun State. For Prof Akpuaka he and his then Registrar, Dr I Igboanugo raised the first fasciocutaneous flap for coverage of leg defects even before this type of flap was described by Ponten.[4] His description of the radial recurrent fasciocutaneous flap[7] has been published in 3rd edition of Grabb’s Encyclopaedia of Upper Extremities.[8] Prof Akpuaka has helped in the establishment of a number of Medical Schools in Nigeria especially in the South East region, and no wonder the Abia State University has decided to honor by appointing the first Professor Emeritus.

These pioneer plastic surgeons helped in the establishment and the growth of the plastic surgery as a specialty in both the national and regional postgraduate medical training colleges which has been instrumental to the growth of the specialty in Nigeria. To the credit of these pioneers and the training colleges the country has produced over 100 plastic surgeons most of whom are practicing within the country. They have in no small way provided the necessary manpower at a lower cost to the country. These colleges have been able to bridge the gap in providing manpower to the country, region and beyond.


  Our today Top


Plastic surgery has come a long way since the specialty was introduced in the country more than 50 years ago. There has been an increase in the number of plastic surgeons that have been trained and providing services in the country. Those pioneers were able to set up training programs in their institutions to train others. These programs helped in no small way in increasing the number of trained plastic surgeons in the country over the years. The programs were initially limited to a few centres like in Enugu, Lagos and Ibadan but more centres have different level of accreditation for the training in plastic surgery. The products have practiced and are currently practicing within the country and some of them have risen to the position of responsibilities within the hospital, universities and the professional bodies. Dr R.E.E Nnabuko is the immediate past President of Pan African Burn Society and currently serving as the Program Chair of the Executive Committee of the International Society for Burn Injuries. Prof O.M. Oluwatosin is currently the Deputy Vice-Chancellor (Administration & Health Services), University of Medical Sciences, Ondo which was established by Ondo State government in 2015. He was one-time Dean of Faculty of Clinical Sciences of the College of Medicine, University of Ibadan. The medical university is the first of its kind in Nigeria, the second was supposed to be in Oturkpo Benue State established by Federal Government but it never took off. Dr J.U. Achebe is the first Fellow in plastic surgery by examination of the West African College of Surgeon and he became the first plastic surgeon to head the National Orthopedic Hospital Enugu. Prof B.C. Jiburum was the foundation President of Association of Surgeons of Nigeria (whose inaugural meeting was in Sokoto) and he was onetime the Provost of College of Medicine & Health Sciences of the Imo State University, Orlu Campus. Dr M.K. Chira is the current Head of Training, Schools, Educations, Research and Statistics of the National Orthopedic Hospital, Igbobi Lagos. Dr I.S. Ogbonnaya is the current Head of Higher Educ./Research Education & Training of the National Orthopedic Hospital, Enugu while Dr J.A. Bolajoko rose to the rank of a General in the Nigerian Airforce. Prof J.K Olabanji (our current President) is the Current Chairman, Medical Advisory Committee (C MAC) of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife. Prof Peter Olaitan, was at one time the Chairman MAC of Ladoke Akintola University Technology (LAUTECH) Teaching Hospital, Osogbo. Today’s speaker (Prof S.J. Yiltok) is the current Dean of the Medical School of the University of Jos, while Prof J.N. Legbo is the current Dean of Clinical Sciences, Usmanu Dan Fodio University, Sokoto. Several of the subsequent generations of Plastic Surgeons have risen to positions of responsibility like Heads of Departments, Chairman MAC, officials of professional association/societies etc.This increase in the number of plastic surgeons is not limited to the number of plastic surgeons but also the number of centres providing such services as well as the scope of services.[9] The number and the distribution of the plastic surgeon are shown in [Table 1]. The distribution shows that there are more plastic surgeons in the southern part of the country. The distribution is not just skewed towards the south but there is an unequal distribution between the geo-political regions of the country. Lagos has the highest number of plastic surgeons and by extension the southwest region. It should be noted that Lagos has the highest concentration of doctors in country and it is also the economic capital of the country. The southeast has the next highest concentration of plastic surgeon, the reason may be because the National Orthopedic Hospital, Enugu, use to have and it is still having the highest concentration of trainers. With the increase in the number tertiary health institutions in the same town more trained plastic have been recruited which has created a cluster in Enugu. Generally, majority of the plastic surgeons are practicing in tertiary health care facilities and these institutions are in urban areas. There just 2 plastic surgeons in the North East, which is the most under served in the country. This is a region that has been under siege by insurgents, the Boko Haram. In 2010 there were 4 plastic surgeons which later improved to 5 but within a short period 3 of them moved out of the region for varying reasons.
Table 1 Distribution of plastic surgeons in Nigeria

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Most of these surgeons, in addition to their local training (either in one or more centres) spent some time in more established centres abroad either during their training or after certification by the national or regional postgraduate medical colleges. The period of contact ranges from a few months to a year or more. This exposure helps in improving their skills and increase the scope of surgery they can do. Most of training was undertaken in Europe (mainly in the UK and Germany), the US and in Asia (mainly in India and Taiwan). These specialist practices mainly in public institutions, with some having part-time practice in private settings, few of the plastic surgeons have elected to practice fully as private practitioners.

The practice of plastic surgery in this part of the world has its own challenges and this has affected the growth of the specialty. Some of these challenges may continue if nothing is done to address them. Some these challenges are:
  1. Inadequate Personnel. There only about 110 plastic surgeons serving a population of over 170 million. This number is part of the little over 35,000 doctors in the register of doctors maintained by the Medical and Dental Council of Nigeria. Medical doctors prefer to specialize in non-surgical specialties except obstetrics and gynecology. Poor remuneration relative to amount of time and effort that is put in by the practitioner affects the number that shows interest in the specialty. There is gradual decline in the prestige of the profession which is due to remuneration especially in the public sector where everybody at the same level is paid the same salary irrespective of the specialty. There is no hope that this will improve as a recent poll show that many doctors want to emigrate to practice outside Nigeria[10] as seen in [Figure 4]. We are already having movement within the country of plastic surgeon, mainly from taking up an appointment after certification and changing employers. We hope it will not reach the level that we will begin to see large emigration of plastic surgeons outside the country.
    Figure 4 Survey Infographics on Survey on Emigration of Nigerian Medical Doctors[10]

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  2. Lack of Awareness of the Practice of Plastic Surgery. A lot of people do not believe plastic surgery is possible in Nigeria, this is more so if it is aesthetic surgery. Surprisingly this happens even amongst health personnel.
  3. Limited Infrastructure for Practice. The hospitals are not well equipped to allow for best practice. There is poor investment in this area as the fear of recouping one’s investment is there.
  4. Poverty and Lack of Universal Health Coverage. A significant part of our population lives on < 1$/per day and this has been made worse by the recession. Most of them cannot afford the cost of treatment. Unfortunately, we do not have universal health coverage to take care of this. The National Health Insurance Scheme (NHIS) is supposed to help to fund treatment but only a small percentage of the population is covered. Most people pay out of pocket for treatment and with poverty most people depend on family members and well-wishers to fund treatment.
  5. Culture and Beliefs. Cultural influence affects our accepting certain aspect of plastic surgery especially if it involves aesthetic surgery. For those who need it and can afford it they may opt to travel out country for such treatment.
  6. Patient Expectation. Sometimes patient’s expectation is beyond reality and so if they are not giving assurances they may opt out or may turn out to be a reason for litigation if the outcome does not meet up with their expectation.
  7. Complications. Most patient do not expect any form of complication and easily get discouraged if they are told that every procedure has its complication.
  8. Complexity of Cases. Some patient might present with complex cases that may require multi-disciplinary management which may not be possible in a center or might require going elsewhere for certain important investigations. With out of pocket funding they may not afford such treatment.
  9. Workload. With fewer plastic surgeons the workload is enormous and where the plastic surgeon shares the same theatre space with others the waiting list will be long.



  Our tomorrow Top


Our tomorrow will depend on what we make of our today. The challenges will remain there except if we work out how we will overcome them either as individuals, profession/group, the private sector and the government. The government has a lot to do to help resolve the issue of inadequate personnel, limited infrastructure, poverty and lack of universal health coverage., workload and to some extent complexity of cases as necessary policies can be implemented to mitigate these challenges either on a short term or on a long-term basis. The prospect of having a better practice and quality care in plastic surgery are there, some of us have embarked on measures to improve on that and efforts should be made not to lose the focus. What are the prospects and the way forward? I will like to discuss them in the perspective and peculiarities of our practice in Nigeria.
  1. Improving Skills and Personal Development. The first set of plastic surgeons went abroad to acquire and improve their knowledge and practice of plastic surgery and this trend has continued to this day. Several members of this association had to go abroad to acquire more knowledge, sometimes the funding is by the individual. The government should make deliberate policies that will help in developing this specialty rather than allow individuals to go through that on their own. The policy should help in pulling resources from several sources which will help in training and re-training of more plastic surgeons and indeed other specialist in the health care industry.
  2. Education. Education has a great influence on how healthy a society will be and we are having an increase in the number of educated individuals who now know about plastic surgery. This knowledge is not limited to aesthetic surgery but also the reconstruction aspect. Even the less educated are beginning to know who a specialist is, even from the everyday observations they know that different people are specialist in different aspect of the same profession.
  3. Advent of Digital Satellite TV, Internet and Social Media. The impact of modern communication on the practice of plastic cannot be overemphasized and it will continue to be so. I believe several members here must have been approached by clients based on what they have seen or read from these media.
  4. Democracy. The advent of democracy has brought some level of freedom and if well managed it will bring in more investment and this will help in building up the middle class (a critical class in a growing economy) which will have adequate fund to assess health care.
  5. Improving the National Health Insurance Scheme (NHIS). There should be a review of the act establishing the NHIS to take care of the policy on the universal health coverage. Operating or implementing the recently signed health act will go a long way in the implementation of the universal health coverage.



  Conclusion Top


The practice of plastic surgery in Nigeria is over half a century and over this period there has been an increase in the number of practitioners as well as the scope of practice. Despite the increase, the number is inadequate considering the population of the country. There is therefore the need to address the challenges that have limited our progress and this requires individual, professional/group, the private sector as well as government intervention to make a difference.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Oluwasanmi JO. Plastic surgery in the Tropics: an introduction for medical students and surgeons. Macmillan international College Editions. London and Basingstoke: Macmillan (Macmillan Tropical and Sub-tropical Medicine Series);1979.  Back to cited text no. 1
    
2.
Oluwasanmi JO. Wounds and wound healing. Akure: Joe-Jane Medical Centre;1995.  Back to cited text no. 2
    
3.
Gingrass RP, Robson MC, Thompson LW, Woods JE, Zook EG. Plastic surgery: essentials for students. 2007. Plastic Surgery Educational Foundation Arlinton Heights.  Back to cited text no. 3
    
4.
Echezona EEC. History of plastic surgery at National Orthopedic Hospital, Enugu. Nigerian Journal of Plastic Surgery 2010;6:52-54.  Back to cited text no. 4
    
5.
Ganguly M. Brigadier Rasasmay Ganguly. Indian J Plast Surg 2014 Jan-Apr;47:4-7.  Back to cited text no. 5
    
6.
Sowemimo GO. Burn care in Africa: reducing the misery index: the 1993 Everett Idris Evans Memorial Lecture. J Burn Care Rehabil 1993;14:589-94.  Back to cited text no. 6
    
7.
Akpuaka FC. The radial recurrent fasciocutaneous flap for coverage of posterior elbow defects. Injury 1991;22:332-4.  Back to cited text no. 7
    
8.
Akpuaka FC. Radial Recurrent fasciocutaneous flap for coverage of posterior elbow defects. In: Strauch B, Vasconez LO, Hall-Findlay EJ, Lee BT, editors. Grabb’s Encyclopedia of Flaps: Upper Extremities. 3rd ed. Philadelphia: Lippincot Williams & Wilkins, a Wolter Kluwer Business; 2009. p. 969-970.  Back to cited text no. 8
    
9.
Chukwuanukwu TOG. Plastic Surgery in Nigeria-Scope and Challenges. Nigeria Journal of Surgery 2011;17:68-72.  Back to cited text no. 9
    
10.
Emigration of Nigerian Medical Doctors − NOI Polls. [cited2017 Aug 4]. Available from: http://noi-polls.com/documents/Emigration_of_Medical_Doctors_Survey_Report.pdf.  Back to cited text no. 10
    


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  In this article
Abstract
Introduction
Plastic surgery
Our yesterday
Our today
Our tomorrow
Conclusion
References
Article Figures
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