Protocol for a systematic review on classification, outcomes and follow-up of patients undergoing reconstructive surgery after Noma disease-

Abstract Background: NOMA is a significant yet neglected disease which affects children in some of the least developed countries in the world. Surgical reconstructive missions for patients affected by NOMA are undertaken regularly by surgeons from more developed countries. However, the long-term benefit and safety of these missions have recently been criticized due to a perceived lack of measurable outcomes and appropriate follow-up. We are conducting a systematic review to critically evaluate the classification systems, outcome measurement tools, and follow-up periods reported in the literature for NOMA disease. Methods: This systematic review is undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (“PRISMA”) guidelines. The databases MEDLINE, Embase and Web of Science are searched from infinity to 24th of April 2019. All original publications of studies undertaken on reconstructive surgery for NOMA disease, reporting data on outcome after surgery, follow-up time and complications are eligible for inclusion. The primary outcome of interest are the outcome measurement methods used for assessing successful reconstructive surgery after NOMA disease. Other outcomes we are assessing are methods for classification of disease severity and time to last follow-up. The quality of evidence for each summary outcome measure is assessed using the MINORS criteria. Discussion: Given the precarious situations in the countries where mission surgeons often undertake reconstructive surgery, time pressure and the lack of infrastructure on site prevent them from being able to measure the effect of their surgical outcomes. Our goal is to express the key points of debate and make recommendations for how future surgical missions can be improved. We aim to do so by comparing the current best standards of practice Publishing this protocol will help future NOMA surgeons plan their missions in a standardised and reproducible way, striving towards a future of worldwide high-quality research.Systematic review registrations: This protocol was submitted to PROSPERO on the 02.10.2020 and is currently under assessment. (ID 181931)