Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Reconstructive Surgery in the Tropics
Figure 69. Advancement rotation flap.
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is continued downward in front of the ear. This will enable this entire block of skin
and subcutaneous tissue to be moved forward and upward. Deep sutures are taken
to position the advancement flap in its new position. Skin sutures, which pass from
the border into the subcutaneous tissue to attach to the subcuticular margin of the
flap and back through the skin of the border, are helpful. A penrose drain is used
with advantage for the first 48 hours.
Complications
A. Bleeding, hematoma formation, and seromas.
B. Infection of operative and donor areas.
C. Necrosis of the distal portion of flaps.
D. Lack of attachment of the flap to the new site.
E. Airway obstructions
F. Corneal injury to the eyes.
Prevention and Treatment of Complications
A. Careful hemostasis is especially important in reconstructive surgery. This
includes tender loving care of the tissues with prevention of desiccation
by covering the operative sites and flaps with saline soaked laparotomy
pads. The use of an appropriately sized penrose, glove, or finger drain for
the first 48 hours is frequently wise. It is a good rule to make sure that all
bleeding is stopped before the operation is terminated. If unexpected bleeding
does develop, take the patient back to the operating room promptly.
Don’t procrastinate hoping that surgery will not be necessary.
B. Infections
a. With strict attention to detail,
b. Careful handling of tissues,
c. Great emphasis on the adequate cleaning and sterilization of all instrument,
drapes, gowns, and gloves,
d. Special care not to crush or burn tissues and
e. The liberal use of traction sutures and skin hooks,
The infection rate should be less than 5%.
Prevention of infection is not usually assisted by the use of antibiotics before,
during or after surgery in reconstructive surgery in the tropics. For treatment, a
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