Bridging Gaps in Surgical Care: Facial Trauma Management Through the Surgeons in Humanitarian Alliance for Reconstruction, Research, and Education Initiative.

Abstract

Facial trauma presents a significant healthcare challenge in low- and middle-income countries (LMICs) due to limited access to specialized surgical care. This case report describes the management of a complex forehead degloving injury in a 20-year-old woman in Somalia, highlighting the role of remote surgical mentorship in resource-limited settings. The patient sustained a right forehead degloving injury in a motor vehicle collision, exposing a 3 × 5 cm segment of the frontal bone. Initial debridement resulted in a large soft-tissue defect, and the local surgical team faced challenges in selecting an optimal reconstructive approach due to limited experience and resources. The patient's aesthetic concerns further complicated decision-making. Through the Surgeons in Humanitarian Alliance for Reconstruction, Research, and Education program, the team sought virtual expert consultation via a secure WhatsApp platform. Based on expert recommendations, conservative management with daily Vaseline dressings was initiated to promote granulation tissue formation. Over 6 weeks, complete bone coverage was achieved, followed by full-thickness skin grafting, resulting in a satisfactory aesthetic outcome. This case demonstrates the value of global surgical networks in guiding complex reconstructions in LMICs, allowing local teams to deliver high-quality care despite resource constraints. Although short-term results were successful, long-term follow-up is necessary to assess functional and aesthetic durability. The success of this case underscores the importance of international collaborations in improving surgical education, patient outcomes, and sustainability of reconstructive techniques in LMICs.