Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Accommodating Deficits in Material and Assistance
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Figure 7. A clamp holding a standard straight
razor blade used for harvesting skin grafts.
complex, costly maintenance and use of the equipment has been limiting: small or
large system malfunctions delay procedures making simple operation more difficult,
reliable technical assistance has not always been available, and fogging of the
lens during cold winter months has been a problem. These factors have swayed us
away from regular use of this technology.
Tricks
With the unavailability of advanced medical technology and equipment, more
basic equipment and materials can be manipulated for use as substitutes. Described
here are some common substitute procedures and materials that have been successfully
utilized at the Lady Willingdon Hospital.
Skin Grafts
In place of using a dermatome, skin grafts are harvested with a straight razor
blade held with a standard clamp (Fig. 7). The graft is harvested by holding the
blade at a 10-15 degree angle and sliding forward with a sawing motion.
Closed Suction Drain
To improvise a closed suction drain, two holes can be cut into the side of a small
feeding tube and attached to a length of IV tubing (Fig. 8). This is then attached to
an IV bottle to create a vacuum using suction applied through a needle that is then
removed.
Intraosseous Needles
A 16 or 18-gauge spinal needle can be cut obliquely 1 inch from the hub to
make an Intraosseous needle. This can be used during fluid resuscitation of a baby
or small child.
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