Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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150 Surgery and Healing in the Developing World
Figure 5. Breast cancer can lead to tetanus. Fifty-three per cent of breast cancer patients
in our Nigerian hospital in the ’80s presented with skin or chest wall involvement, Stage
IIIB.
Many patients in the DW present with pus in the extremities or the body wall.
In addition to routine skin and subcutaneous abscesses, osteomyelitis, pyarthrosis,
and pyomyositis are everyday occurrences in a DW general surgery practice. Almost
all abscesses should be drained widely (ketamine is your greatest ally here) and left
open to heal by secondary intention. Antibiotics appropriate for staphylococcus are
expensive, if available at all, and should never be used as a substitute for wide drainage.
It is important for the DW general surgeon to know a safe approach to all bones
and joints in the body. Hoppenfeld’s Exposures in Orthopedics provides such an approach
and is well worth the investment. Hand infections are common, and familiarity
with proper drainage techniques for felons, paronychiae, and tendon sheath/
palmar space abscesses is vital.
Men with urinary retention present frequently to DW hospitals. The three main
causes are: benign prostatic hypertrophy (BPH), prostatic cancer, and postinflammatory
urethral stricture. The first step in management should be an attempt
at passage of a urethral catheter. If catheter placement is successful, urethral
stricture is probably not the etiology of the obstruction. After drainage of the dis-