Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Abscesses and Other Infections Treated by Surgery
Figure 22. Leprosy (Hansen’s disease).
Figure 23. Severely-burned
insensate feet in a man with
leprosy.
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Leprosy
Leprosy (Fig. 22) is usually a slowly progressive infection that destroys sensory
nerves, thus preventing the patient from feeling his or her extremities being injured
or burned (Fig. 23). Chronic or acute abscesses are drained as necessary. Most of the
surgical role in this infection is reconstruction along with physiotherapy and measures
to prevent further damage.
Sump Drain
We have discussed the use of a sump drain for intra-abdominal and retroperitoneal
abscesses. A most useful and simple sump drain is pictured in Figures 24 and
25a and b. The principle is to aspirate pus or fluid without sucking on tissues. An
outer sheath keeps tissues away from the holes of the suction tube so that they are
not obstructed and so that bowel or other vulnerable structures are not injured by
the suction. Holes in the outer sheath allow pus and fluid through to the suction
drain. The outer sheath is open to air to prevent the formation of a vacuum which
would suck tissue up against the holes in the outer sheath. If the inner tube becomes
plugged, it is easy to change while leaving the outer tube in place. Once the abscess
is reduced to a tract, the inner tube is removed and the outer tube left as a passive
drain to be withdrawn gradually.
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