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Congenital Blepharoptosis Dynamic Reconstruction: The Nicaragua Narrative of a Self-Sustaining Global Health Model
Amanda Nelson, MD1, Gustavo Herdocia Baus, MD2, Ruston Sanchez, M.D.3, John Noon, MD1, Michael Bentz, MD1, John Siebert, MD1, Samuel Poore, MD, PhD1.
1University Of Wisconsin Hospitals and Clinics, Madison, WI, USA, 2Universidad Nacional Autonoma de Nicaragua, Leon, Nicaragua, 3University Of Wisconsin, Madison, WI, USA.

To establish an international residency program to educate and train local surgeons in plastic and reconstructive techniques in order to provide timely care with longitudinal follow-up.

In 1991, recognizing a demand too great to be addressed by humanitarian mission alone, the University of Wisconsin Division of Plastic surgery established a residency in Nicaragua to educate and train local surgeons. The success of the program is highlighted through a series of dynamic reconstruction of congenital blepharoptosis performed by the first Nicaraguan resident (G. Herdocia). The novel technique of minimally invasive fascia lata harvest, weaving of the fascia from tarsal plate to frontalis at an appropriate tension to maximize a reliable aesthetic and functional result will be presented.
In 1996 over 400 plastic surgeries were performed following graduation of the first Nicaraguan resident; by graduation of the fourth trainee the annual operative volume exceeded 1000 cases. During the same time frame the visiting plastic surgeon operative case log remained consistently near 150. Since the inception of the Nicaraguan residency a multiplier effect has been established with significant incremental increase in the number of surgeries performed annually.
The University of Wisconsin experience demonstrates an effective self-sustaining global health model. The first locally trained resident is now the Chairman of Plastic Surgery at the León Medical School, Nicaragua. His series of congenital blepharoptosis demonstrates the feasibility of autologous fascia lata use in infants and the predictable lasting post-operative result.

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