Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Reconstructive Surgery in the Tropics
Figure 2. Loss of nose from “noma” in infancy.
Figure 3. Forehead flap for nasal
reconstruction. Turn over paranasal
flaps for under surface and inside
lining of nose.
Figure 4. Total elevated forehead flap based
on left temporalis artery.
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Let me guide you through a typical operation such as a complete nasal reconstruction
using a total forehead flap.
1. An anterior and lateral preoperative picture is taken for study and analysis.
Sketches are an alternative.
2. Give a general endotracheal anesthesia using ketamine as an I.V. drip. This
is made up from 10 cc of ketamine containing 50 mg per cc and placed in
500 cc of normal saline with 5% glucose. This makes up an I.V. with 500
mg of ketamine in 500 cc of normal saline with glucose. For the induction
of a 70 kg man, give 140 drops per minute. Maintenance is given at 70
drops per minute. An appropriate dose of atropine would be 0.5 mg. Intu-
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