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Pakistan Earthquake: Experiences of a Multidisciplinary Surgical Team

Published online by Cambridge University Press:  28 June 2012

Asim Rajpura ,
Ihab Boutros ,
Tahir Khan  and
Sohail Ali Khan
Asim Rajpura*
Affiliation:
Department of Orthopedics, Hope Hospital, Salford, UK
Ihab Boutros
Affiliation:
Department of Orthopedics, Hope Hospital, Salford, UK
Tahir Khan
Affiliation:
Department of Orthopedics, Hope Hospital, Salford, UK
Sohail Ali Khan
Affiliation:
Department of Orthopedics, Hope Hospital, Salford, UK
*
6 Manthorpe Ave., Worsley, Greater Manchester UK, M28 2AZ, E-mail: asimrajpura@gmail.com
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Abstract

Introduction:

Four weeks after the earthquake in Kashmir, Pakistan, multi-disciplinary surgical teams were organized within the United Kingdom to help treat disaster victims who had been transferred to Rawalpindi. The work of these teams between 05-17 November 2005 is reviewed, and experiences and lessons learned are presented.

Methods:

Two self-sufficient teams consisting of orthopedic, plastic surgical, anesthetic, and theatre staff were deployed consecutively over a two-week period. A trauma unit was set up in a donated ward within a private ophthalmological hospital in Rawalpindi.

Results:

Seventy-eight patients with a mean age of 23 years were treated: more than half (40) were <16 years of age. Fifty-two patients only had lower limb injuries, 18 upper limb injuries, and eight combined lower and upper limb. The most common types of injuries were: (1) tibial fractures (n = 24), with the majority being open grade 3B injuries (n = 22); (2) femoral fractures (n = 11); and (3) forearm fractures (n = 9). Almost half (n = 34) of the fractures were open injuries requiring soft tissue cover.

Over 12 days, 293 operations were performed (average 24.4 per day). A total of 202 examinations under anesthesia, washouts, and debridements were performed. The majority of wounds required multiple washouts prior to definitive procedures. Thirty-four definitive orthopedic procedures (fixations) and 57 definitive plastic procedures were performed. Definitive orthopedic procedures included 15 circular frame fixations of long bones, nine of which required acute shortening and five open reduction and internal fixation of long bones. Definitive plastic procedures included 21 skin grafts, four amputations, 11 revisions of amputations, 20 regional flaps, and one free flap.

Conclusions:

A joint ortho-plastic approach was key to the treatment of the spectrum of injuries encountered. Only four patients required fresh amputations. Twenty patients may have required amputation without the use of ring fixators and soft tissue reconstruction. Having self-sufficient teams along with their own equipment and supplies also was mandatory in order not to put further demand on already scarce resources. However, mobilizing such teams logistically was difficult, and therefore, an organization consisting of willing volunteers for future efforts has been established.

Keywords

earthquakeIlizarovKashmirlimb reconstructionmultidisciplinaryorthopedicPakistanplastic surgery
Type
Case Study
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 4 , August 2010 , pp. 361 - 367
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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