The non-cosmetic plastic surgeries
Jul 11, 2014
When we talk about plastic surgery, many people may think of surgery for cosmetic purpose but out in the field there are many patients with wounds that are so big and without skin coverage. If one does not have the skill, the only thing one can do is continuously washing and dressing of the wound and hope the wound will heal after a long long time, or the wound may get infected, and the patient might as well lose the limbs or even can die of infection.
The most basic plastic surgery (or better called reconstructive surgery) is skin graft. In Bossangoa, there are lots of patients with open wounds as the result of gunshot, infection, burn or motor accidents. In 2 months I have already done 18 skin grafts for all these kinds of patients to spare them from repeated and endless cleaning of their wounds, not to mention to spare their limbs.
But some wounds are more difficult to be covered and cannot be covered with a skin graft. Like I've two patients with the leg bone exposed and I needed to do a muscle flap to cover the exposed bone before the skin graft can be taken. One of them could avoid an amputation that the other doctors thought that's the only choice but I saved his leg. As for the other 5-year-old girl, I saved her leg which will never grow normal, but at least I eliminated the chance of her losing it
Also there is a boy with a big area of infection in the left lower abdomen and the groin so at the end I needed to rotate a myocutaneous flap from the right side of the abdomen to cover the big area. I'm so happy the wound healed nicely and spared him of endless cleaning with easy infection. Lastly there is a 14-year-old young lady that came from outside village with her right leg and foot badly infected for 3 weeks before coming to our hospital. After taking out all the dead and infected skin and tissues, the lower half of the lateral side of the leg and the dorsum of the foot are all exposed.
At first look everyone will just consider an amputation but at the end I did a cross leg flap for her, using the skin from the opposite leg to cover the diseased side and covering the donor site with skin graft. With this, she is now recovering but the course will take 4-5 weeks. So even in the field with primitive environment and basic instruments, this bush surgeon can still do a lot of "plastic surgery" that you won't have expected!
By the way, it is always harsh out in the field, but I was very lucky in the last 6 missions being got sick once only. It was when I got gastritis after brushing my teeth with water from our water tank and then found that there was a dead eagle inside the tank! But in this mission, up to now I've been sick for 4 times with flu, vomiting, diarrhoea....The only good thing is I did not contact malaria!