Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Accommodating Deficits in Material and Assistance
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Figure 10. A hand under
the sterile drape holding a
retractor.
Figure 11. A Thomas splint
made with a custom
welded metal frame.
Extra Hands
When a retractor needs to be held but an extra hand in not available, the person
monitoring the patient can place his hand under the drape and hold a retractor
without placing his hand on the sterile field (Fig. 11). This is especially useful to
retract the right costal margin cephalad during gallbladder surgery.
Thomas Splint
For femoral fractures, a Thomas splint can be fashioned with a wood or welded
metal frame. Rope can be attached to the leg with an ace bandage and adhesive tape.
It is important to apply equal pressure around the leg to prevent excessive compression
in one place.
A Note on Sutures
Most basic procedures can be completed with the following sutures: 3-0 silk, 0
and 2-0 catgut, 2-0 and 3-0 vicryl and six-pound-test fishing line. We regularly
perform laparotomy, cholescystectomy, herniorraphy, ureteral stone removal, Cesarean
section and hysterectomy using only these suture materials at the surgical
camps. It is important to have free needles with eyelets also available.
Results
Below is a table of the last 500 operations performed at the Lady Willingdon
main hospital and surgical camps utilizing the methods described in this chapter
(Table 1). The table shows that a vast array of surgical cases can be performed with
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