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Yasar B, Ozbilgehan P, Sen M, Guvendik A. Influence of systemic inflammatory indices on hospital stay and dialysis post-earthquake: A clinical study. PLoS One 2024; 19:e0299737. [PMID: 38416755 PMCID: PMC10901347 DOI: 10.1371/journal.pone.0299737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024] Open
Abstract
Natural disasters pose significant challenges to medical response due to the surge of patients and emergent injuries. Amid such scenarios, where personnel for patient monitoring might be scarce, effective biomarkers are crucial for guiding treatment plans and predicting patient prognosis. We aimed to evaluate the correlation between systemic inflammatory indices and morbidity in earth-quake-induced crush injuries. Additionally, we assessed the potential of these indices as prognostic markers for adverse outcomes. We studied 140 patients with earthquake-related crush injuries (ECR) admitted between February and March 2023 and compared them to 200 healthy controls (CG) chosen using a simple random method. Using the complete blood count data upon admission, we computed and statistically compared indices including NLR (neutrophil lymphocyte ratio), PLR (platelet lymphocyte ratio), MLR (monocyte lymphocyte ratio), SII (systemic immune-inflammatory index), SIRI (systemic inflammatory response index), and PIV (pan-immune inflammation value). Regression analyses determined the prediction of hospitalization duration and dialysis necessity. PLR and MLR upon admission significantly predicted the length of hospital stay. MLR and SIRI were significant predictors for dialysis requirement, with Exp(B) values of 0.306 (p = 0.024) and 1.261 (p = 0.038), respectively. Systemic inflammatory indices can serve as valuable prognostic tools in disaster scenarios. Utilizing these indices can enhance patient management, effectively allocate resources, and potentially save lives in the aftermath of earthquakes.
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Affiliation(s)
- Burak Yasar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Bilkent City Hospital, Health Sciences University, Ankara, Türkiye
| | - Pınar Ozbilgehan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Bilkent City Hospital, Health Sciences University, Ankara, Türkiye
| | - Mert Sen
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Bilkent City Hospital, Health Sciences University, Ankara, Türkiye
| | - Arslan Guvendik
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Bilkent City Hospital, Health Sciences University, Ankara, Türkiye
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75 Years of Hand and Peripheral Nerve Surgery in Plastic and Reconstructive Surgery: Standing on the Shoulders of Giants. Plast Reconstr Surg 2021; 147:1473-1479. [PMID: 34019521 DOI: 10.1097/prs.0000000000008003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lu S, Han P, Wen G, Wang C, Wang Y, Zhong W, Wang H, Chai Y. Establishing an Evaluation System and Limb-Salvage Protocol for Mangled Lower Extremities in China. J Bone Joint Surg Am 2019; 101:e94. [PMID: 31567809 DOI: 10.2106/jbjs.18.01302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Road traffic accident-related severely injured extremities account for the majority of disabilities in young people in China. Limb-salvage concepts and techniques vary greatly from physician to physician and from district to district in China. Current severity-scoring systems for lower-extremity injuries lack sensitivity and cannot be used as the sole criterion by which amputation decisions are made. China lacks a national database of mangled lower extremities, which is a priority for both limb-salvage protocols and scoring system development.
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Affiliation(s)
- Shengdi Lu
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Pei Han
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Gen Wen
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Chunyang Wang
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yanmao Wang
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Wanrun Zhong
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Hongshu Wang
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yimin Chai
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
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A pilot registry of trauma surgeons willing and ready to respond to disasters. J Trauma Acute Care Surg 2019; 84:393-396. [PMID: 29251703 DOI: 10.1097/ta.0000000000001751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A well-defined means of organizing surgeons based on functional capabilities in disaster response has been lacking. We sought to create a pilot registry of surgeons, organized by functional capacities, available to respond to disasters in conjunction with the American College of Surgeons Operation Giving Back and to better understand their participation in disaster medicine training. METHODS The authors conducted a survey of the members of the American Association for the Surgery of Trauma and the Eastern Association for the Surgery of Trauma aimed at establishing a pilot registry of qualified trauma surgeons available to respond to disasters. Data from the surveys were analyzed retrospectively for surgical and subspecialty training, board certification, disaster response training, and military or civilian disaster experience to better understand the respondents' functional capacities and disaster training backgrounds. RESULTS Of 211 respondents, 96% self-identified as trauma surgeons, whereas 87% and 89% reported active practice in acute care surgery and/or critical care. Nearly all had primary board certifications in general surgery (93%), and many had additional certifications in surgical critical care (65%). While many reported participation in American College of Surgeons-sponsored trauma courses, only 30% of those surveyed received disaster-specific training in Federal Emergency Management Agency courses, and even fewer received training in the Disaster Management and Emergency Preparedness course. Few had military (26%) or civilian (19%) experience in disaster response. CONCLUSIONS This initiative complements efforts to organize a registry of trauma surgeons who are qualified and willing to respond in all aspects of disaster response. While trauma surgeons are optimally positioned to provide a wide range of surgical expertise in a disaster, this study further demonstrated the lack of a universally accepted disaster training program for surgeons willing to respond to mass casualty incidents. Standardized disaster response training for surgeons remains a challenge for the future. LEVEL OF EVIDENCE Care management, level IV.
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Qudsi RA, Roberts HJ, Bhashyam AR, Losina E, Bae DS, Alexis F, Dyer GS. A Self-Reported Needs Assessment Survey of Pediatric Orthopaedic Education in Haiti. JOURNAL OF SURGICAL EDUCATION 2018; 75:140-146. [PMID: 28864264 PMCID: PMC6122854 DOI: 10.1016/j.jsurg.2017.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/13/2017] [Accepted: 06/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The burden of musculoskeletal disease remains high in low-income countries, with a high rate of pediatric disease. Efforts continue for orthopedic education, but there is little guidance on local needs and desires. Our aim was to determine the specific content and modalities that would be most useful for pediatric orthopedic educational programs abroad, and we demonstrate a practical method of identifying country-specific educational deficits through a self-reported needs survey in Haiti. DESIGN A cross-sectional survey was administered using an automated response system. We obtained demographic information as well as training and practice patterns, comfort levels with pediatric diagnoses, and desired topics for education using a 5-point Likert Scale. SETTING Haitian Annual Assembly for Orthopaedic Trauma (HAAOT), the only national, continuing medical education conference for orthopedic providers in Haiti. PARTICIPANTS Of 60 eligible participants, 51 were included in the final analysis. RESULTS Time spent on pediatric orthopedics varied widely, centered at 10% to 25%. Median comfort level with pediatric orthopedics was 3 of 5. Skills with lowest self-reported competence included spica casting, clubfoot casting, and management of supracondylar humerus fractures. Skills with highest self-reported competence were long-leg casting and Salter-Harris classification. Modes of education highly requested included didactics/lectures, hands-on sessions, dedicated rotations, and exchanges with foreign peers/mentors. Diagnoses most encountered were osteomyelitis, trauma, and clubfoot; lowest comfort levels were in neuromuscular, spine, lower extremity deformity, congenital hip, and clubfoot; and most requested for future teaching were congenital hip, neuromuscular, and spine. CONCLUSIONS Haitian orthopedic providers express a strong desire and need for ongoing pediatric orthopedic education. They describe a high prevalence of trauma and infection, but convey a requirement for more comprehensive, multimodal teaching that also includes congenital deformities/dysplasias, neuromuscular, and spine. Our results demonstrate the importance of assessing country-specific needs and involving local care providers in curriculum development.
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Affiliation(s)
- Rameez A Qudsi
- Department of Orthopaedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Brigham and Women's Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts; Harvard Combined Orthopaedic Residency Program, Harvard University, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Heather J Roberts
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Abhiram R Bhashyam
- Harvard Combined Orthopaedic Residency Program, Harvard University, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Elena Losina
- Department of Orthopaedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts; Department of Orthopaedic Surgery, Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Donald S Bae
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Francel Alexis
- Department of Orthopaedic Surgery, Adventist Hospital, Diquini, Haiti
| | - George S Dyer
- Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Bar-On E, Blumberg N, Joshi A, Gam A, Peyser A, Lee E, Kashichawa SK, Morose A, Schein O, Lehavi A, Kreiss Y, Bader T. Orthopedic Activity in Field Hospitals Following Earthquakes in Nepal and Haiti. World J Surg 2016; 40:2117-22. [DOI: 10.1007/s00268-016-3581-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vaishya R, Agarwal AK, Vijay V, Hussaini M, Singh H. Surgical Management of Musculoskeletal Injuries after 2015 Nepal Earthquake: Our Experience. Cureus 2015; 7:e306. [PMID: 26430580 PMCID: PMC4578712 DOI: 10.7759/cureus.306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
We report our experience of handling 80 major musculoskeletal injuries in a brief span of three days immediately after the major earthquake of Nepal in April 2015. Planning, proper utilization of resources, and prioritizing the patients for surgical intervention is highlighted. The value of damage control by orthopaedics in these disasters is discussed. Timely and appropriate surgical treatment by a skilled orthopaedic team not only can save these injured limbs but also the lives of the victims of a major disaster.
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Abstract
Disasters cause untold damage and are often unpredictable; however, with proper preparation, these events can be better managed. The initial response has the greatest impact on the overall success of the relief effort. A well-trained multidisciplinary network of providers is necessary to ensure coordinated care for the victims of these mass casualty disasters. As members of this network of providers, plastic surgeons have the ability to efficiently address injuries sustained in mass casualty disasters and are a valuable member of the relief effort. The skill set of plastic surgeons includes techniques that can address injuries sustained in large-scale emergencies, such as the management of soft-tissue injury, tissue viability, facial fractures, and extremity salvage. An approach to disaster relief, the types of disasters encountered, the management of injuries related to mass casualty disasters, the role of plastic surgeons in the relief effort, and resource management are discussed. In order to improve preparedness in future mass casualty disasters, plastic surgeons should receive training during residency regarding the utilization of plastic surgery knowledge in the disaster setting.
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Read DJ, Holian A, Moller CC, Poutawera V. Surgical workload of a foreign medical team after Typhoon Haiyan. ANZ J Surg 2015; 86:361-5. [PMID: 25997691 DOI: 10.1111/ans.13175] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND On 8 November 2013, Typhoon Haiyan struck the Philippines causing widespread loss of lives and infrastructures. At the request of the Government of the Philippines, the Australian Government deployed a surgical field hospital to the city of Tacloban for 4 weeks. This paper describes the establishment of the hospital, the surgical workload and handover to the local health system upon the end of deployment. METHODS A Microsoft excel database was utilized throughout the deployment, recording demographics, relationship to the typhoon and surgical procedure performed. RESULTS Over the 21 days of surgical activity, the Australian field hospital performed 222 operations upon 131 persons. A mean of 10.8 procedures were performed per day (range 3-20). The majority (70.2%) of procedures were soft tissue surgery. Diabetes was present in 22.9% and 67.9% were typhoon-related. The Australian Medical Assistance Team field hospital adhered to the World Health Organization guidelines for foreign medical teams, in ensuring informed consent, appropriate anaesthesia and surgery, and worked collaboratively with local surgeons, ensuring adequate documentation and clinical handover. CONCLUSION This paper describes the experience of a trained, equipped and collaborative surgical foreign medical team in Tacloban in the aftermath of Typhoon Haiyan. Sepsis from foot injuries in diabetic patients constituted an unexpected majority of the workload. New presentations of typhoon-related injuries were presented throughout the deployment.
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Affiliation(s)
- David J Read
- National Critical Care and Trauma Response Centre, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Annette Holian
- National Critical Care and Trauma Response Centre, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Cea-Cea Moller
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Sommar P, Granberg Y, Halle M, Skogh ACD, Lundgren KT, Jansson KÅ. Effects of a formalized collaboration between plastic and orthopedic surgeons in severe extremity trauma patients; a retrospective study. J Trauma Manag Outcomes 2015; 9:3. [PMID: 25901178 PMCID: PMC4404286 DOI: 10.1186/s13032-015-0023-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 03/13/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Severe trauma to the extremities often includes a combination of fractures and soft tissue injuries. Several publications support that the patient outcome is better when skeletal stabilization is followed by early soft-tissue coverage. In an effort to optimize the treatment of these patients, we established a formalized collaboration in 2008 between the Departments of reconstructive plastic surgery and orthopedics at the Karolinska University Hospital. METHODS A retrospective review was conducted for all patients who had suffered severe extremity trauma and received either a free or a pedicled flap for extremity reconstruction. We compared the management of patients 0-4 years before and 0-4 years after the collaboration started especially with respect to; choice of flap, time to flap coverage, number of operations/revisions, total in-hospital stay. RESULTS After initiation of the collaboration, the number of flaps increased from 13 flaps (5 free and 8 pedicled) to 44 flaps (21 free and 23 pedicled). Fewer postoperative revisions was seen, as well as shorter in-hospital stay. CONCLUSIONS The present study highlights the importance of formalized collaboration between orthopedic and plastic surgeons in severe extremity trauma patients. The concept of an interdisciplinary approach has led to an increased number of trauma patients referred for plastic surgical consultation, an increased number of flaps, fewer postoperative revisions and shorter hospital stay.
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Affiliation(s)
- Pehr Sommar
- Department of Molecular Medicine and Surgery, Section of Plastic Surgery, Karolinska Institutet and Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Yamin Granberg
- Department of Orthopedic Surgery Västerås Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - Martin Halle
- Department of Molecular Medicine and Surgery, Section of Plastic Surgery, Karolinska Institutet and Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Ann-Charlott Docherty Skogh
- Department of Molecular Medicine and Surgery, Section of Plastic Surgery, Karolinska Institutet and Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Kalle T Lundgren
- Department of Molecular Medicine and Surgery, Section of Plastic Surgery, Karolinska Institutet and Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Karl-Åke Jansson
- Department of Molecular Medicine and Surgery, Section of Orthopedics and Sports Medicine, Karolinska Institutet and Karolinska University Hospital Stockholm, Stockholm, Sweden
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Clover AJP, Jemec B, Redmond AD. The Extent of Soft Tissue and Musculoskeletal Injuries after Earthquakes; Describing a Role for Reconstructive Surgeons in an Emergency Response. World J Surg 2014; 38:2543-50. [DOI: 10.1007/s00268-014-2607-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Why we are here: early reflections on the role of reconstructive plastic surgery in the 2013 Boston marathon bombings. Plast Reconstr Surg 2013; 132:1623-1627. [PMID: 24281588 DOI: 10.1097/prs.0b013e3182a98054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The 2013 Boston Marathon bombings resulted in a large and unexpected influx of patients requiring acute multidisciplinary surgical care. The authors describe the surgical management experience of these patients at Brigham & Women's Hospital and Brigham & Women's Faulkner Hospital, with a particular focus on the important role played by reconstructive plastic surgery. The authors suggest that this experience illustrates the value of reconstructive plastic surgery in the treatment of these patients specifically and of trauma patients in general, and argue for the increasing importance of promoting our identity as a specialty.
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Delauche MC, Blackwell N, Le Perff H, Khallaf N, Müller J, Callens S, Allafort Duverger T. A Prospective Study of the Outcome of Patients with Limb Trauma following the Haitian Earthquake in 2010 at One- and Two- Year (The SuTra2 Study). PLOS CURRENTS 2013; 5. [PMID: 24818064 PMCID: PMC4011624 DOI: 10.1371/currents.dis.931c4ba8e64a95907f16173603abb52f] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Severe limb trauma is common in earthquake survivors. Overall medium
term outcomes and patient-perceived outcomes are poorly documented. Methods and
Findings The prospective study SuTra2 assessed the functional and socio-economic
status of a cohort of patients undergoing surgery for limb injury resulting in
amputation (A) or limb preservation (LP) one year and two years after the 2010
Haiti earthquake. 305 patients [A: n=199 (65%), LP: n=106 (35%)] were evaluated.
Their characteristics were: 57% female; mean age 31 years; 74% of principal
injuries involved the lower limb; 46% of patients had an additional severe
injury; 60% had fractures, of which two-thirds were compound or associated with
severe soft tissue damage; 15% of amputations were traumatic. At 2 years, 51% of
patients were satisfied with the functional outcome (A: 52%, LP: 49%, ns).
Comparison with the 1-year status indicates a worsening of the perceived
functional status, significantly more pronounced in amputees, and an increase in
pain complaints, mainly in amputees (62% and 80% of pain in overall population
at 1- and 2-year respectively). Twenty eight percent (28%) of LP and 66% of A
considered themselves as “cured”. 100% of LP and 79% of A would have chosen a
conservative approach if an amputation was medically avoidable. Two years after
the earthquake, 23·5 % of patients were still living in a tent, 30% were
working, and 25·5% needed ongoing surgical management. Conclusions Only half the
patients with severe limb injuries, whether managed with amputation or limb
preservation, deemed their functional status satisfactory at 2 years. The
patients’ perspective, clearly favors limb conservative management whenever
possible. Prolonged care and rehabilitation are needed to optimize the outcome
for earthquake survivors with limb injuries. Humanitarian respondents to
catastrophes have professional and ethical obligations to provide optimal
immediate care and ensure scrupulous attention to long-term management. Keywords
Haiti earthquake, limb injury, two-year outcome, patients’ perspective,
amputation, limb salvage
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Affiliation(s)
| | | | - Hervé Le Perff
- The Alliance for International Medical Action ALIMA, Fann Résidence, BP15530The Alliance for International Medical Action (ALIMA)
| | | | - Joël Müller
- Université Lille Nord de France - Université d'Artois
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Eardley WGP, Martin KR, Taylor C, Kirkman E, Clasper JC, Watts SA. The Development of an Experimental Model of Contaminated Muscle Injury in Rabbits. INT J LOW EXTR WOUND 2012; 11:254-63. [DOI: 10.1177/1534734612465623] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extent of tissue trauma and contamination determine outcome in extremity injury. In contrast to fracture, osteomyelitis, and closed muscle injury studies, there are limited small animal models of extremity muscle trauma and contamination. To address this we developed a model of contaminated muscle injury in rabbits. Twenty-eight anesthetized New Zealand White rabbits underwent open controlled injury of the flexor carpi ulnaris (FCU). Twenty-two animals had subsequent contamination of the injured muscle with Staphylococcus aureus. All animals were sacrificed at 48 hours and the level of muscle injury and contamination determined by quantitative histological and microbiological analysis. A 1-kg mass dropped 300 mm onto the mobilized FCU resulted in localized necrosis of the muscle belly. Delivery of a mean challenge of 3.71 × 106 cfu/100 µL S aureus by droplet spread onto the injured muscle produced a muscle contamination of 8.79 × 106 cfu/g at 48 hours. Ipsilateral axillary lymph nodes demonstrated clinically significant activation. All animals had normal body temperature and hematological parameters throughout and blood and urinalysis culture at autopsy were negative for organisms. This model allows reproducible muscle injury and contamination with the organism ubiquitous to extremity wound infection at a level sufficient to allow quantitative assessment of subsequent wound care interventions without incurring systemic involvement.
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Affiliation(s)
| | - Kevin R. Martin
- Defence Science and Technology Laboratory, Salisbury, Wiltshire, UK
| | - Chris Taylor
- Defence Science and Technology Laboratory, Salisbury, Wiltshire, UK
| | - Emrys Kirkman
- Defence Science and Technology Laboratory, Salisbury, Wiltshire, UK
| | | | - Sarah A. Watts
- Defence Science and Technology Laboratory, Salisbury, Wiltshire, UK
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Critically assessing the Haiti earthquake response and the barriers to quality orthopaedic care. Clin Orthop Relat Res 2012; 470:2895-904. [PMID: 22487879 PMCID: PMC3442014 DOI: 10.1007/s11999-012-2333-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 03/21/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although numerous authors have described surgical experiences following major disasters, little is known regarding the needs of and barriers to care faced by surgeons during such disasters. QUESTIONS/PURPOSES We therefore (1) identified and compared recurrent interview themes essential to the disaster response following the 2010 Haiti earthquake; (2) determined the difference in reported disaster equipment management task difficulty between disaster-trained and untrained volunteers; and (3) approximated the quantity of various procedures performed. METHODS We conducted 14 interviews with selected orthopaedic surgeon volunteers. We also invited the 504 members of the American Academy of Orthopaedic Surgeons (AAOS), who registered as Haiti earthquake volunteers, to complete an online survey; 174 (35%) completed the survey and 131 (26%) were present in Haiti during the 30 days after the earthquake. Recurrent interview themes were identified, quantified, and compared using Poisson regression analysis. The difference in disaster equipment management difficulty scores was determined with a Wilcoxon rank-sum test. RESULTS Of 10 recurrent interview themes, group organization (31 occurrences) was mentioned much more often than all but two of the remaining nine themes. Compared with disaster-untrained respondents, equipment management tended to be less challenging for disaster-trained respondents. Transporting to the treatment site and security during storage at the site were less challenging (19.5% and 16.5% decreases, respectively). Revision surgeries, guillotine amputations, fasciotomies, and internal fixations, suggestive of inappropriate disaster care, were frequently reported. CONCLUSIONS Organizational and training barriers obstructed orthopaedic care delivery immediately after the Haiti earthquake. Disaster training and outcomes require further study to improve care in future catastrophes.
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