Surgery and Healing in the Developing World - Dartmouth-Hitchcock
Surgery and Healing in the Developing World - Dartmouth-Hitchcock Surgery and Healing in the Developing World - Dartmouth-Hitchcock
Accommodating Deficits in Material and Assistance 351 Figure 3. A surgeon wearing the plastic gown and sterile sleeves used in the surgical camps. Foot-Powered Suction Foot-powered vacuum devices work well when electric suction is not available and provide good backup when power fails (Fig. 5). If possible, it’s a good idea to have two on hand in case a large amount of suction is required. Surgical Technique Careful, rapid surgical technique and minimal tissue manipulation reduce the chance of wound infections. Speedy operations also decrease fluid resuscitation needs. Additionally, rapid technique allows for procedures, including laparotomy, to be done under spinal anesthesia. Instrument ties are nearly always employed to conserve valuable suture material. Figure 4. A surgeon wearing a battery-powered sports headlight. 34
34 352 Surgery and Healing in the Developing World Figure 5. A foot-powered suction device. Fishing Line for Skin Closure Standard six-pound test nylon fishing line can replace 3-0 nylon or prolene suture material (Fig. 6). It is cut into usable lengths and autoclaved. Prior to use, it is threaded twice through a free curved cutting needle. This material is used to close the skin and can also be reliably used to close fascia in abdominal closure or herniorraphy. Cotton Thread to Replace Silk Suture Standard cotton sewing thread can be used in place of silk. It has been used for the serosal closure in two layer bowel anastamoses and has also been used for skin closure. Sterility is achieved through autoclaving. A Note on Laparoscopy Laparoscopy is used occasionally, but in our experience the benefits of this technique have not been found to outweigh the associated difficulties and risks in our patient population. Our patients do not request laparoscopy and do not place much importance on minimizing the size of scars at incision sites. In addition, the Figure 6. Sterilized six-pound-test nylon fishing line used for skin closure.
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Accommodat<strong>in</strong>g Deficits <strong>in</strong> Material <strong>and</strong> Assistance<br />
351<br />
Figure 3. A surgeon wear<strong>in</strong>g <strong>the</strong> plastic<br />
gown <strong>and</strong> sterile sleeves used <strong>in</strong> <strong>the</strong><br />
surgical camps.<br />
Foot-Powered Suction<br />
Foot-powered vacuum devices work well when electric suction is not available<br />
<strong>and</strong> provide good backup when power fails (Fig. 5). If possible, it’s a good idea to<br />
have two on h<strong>and</strong> <strong>in</strong> case a large amount of suction is required.<br />
Surgical Technique<br />
Careful, rapid surgical technique <strong>and</strong> m<strong>in</strong>imal tissue manipulation reduce <strong>the</strong><br />
chance of wound <strong>in</strong>fections. Speedy operations also decrease fluid resuscitation needs.<br />
Additionally, rapid technique allows for procedures, <strong>in</strong>clud<strong>in</strong>g laparotomy, to be<br />
done under sp<strong>in</strong>al anes<strong>the</strong>sia. Instrument ties are nearly always employed to conserve<br />
valuable suture material.<br />
Figure 4. A surgeon wear<strong>in</strong>g<br />
a battery-powered<br />
sports headlight.<br />
34
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