A team of plastic and orthopedic surgeons achieved a high success rate in limb salvage—minimizing the need for amputations—among patients injured in last year's devastating earthquake in Haiti, reports a study in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
Mobilized in the acute phase of disaster response, this "ortho-plastic limb salvage team" approach provides expert surgical care to severely injured patients under the most difficult conditions. "This study gives valuable information on the range and frequency of procedures over time, which can be used to help in the preparation for any future emergencies and demonstrates a low amputation rate for the patients treated," according to the new report by Dr. Anthony James Clover of Cork University Hospital, Ireland, and colleagues.
Temporary Hospital Placed Priority on Limb-Saving Surgery
Dr. Clover and colleagues detail their experience on a surgical team that traveled to Haiti in the aftermath of the devastating earthquake on January 12, 2010. The trip was organized by the British Association of Plastic Reconstructive and Aesthetic Surgeons, in partnership with Medical Emergency Response International. A preliminary team was on the ground in Haiti by January 15. By January 20, surgical procedures were being performed in a tent hospital set up on a tennis court in a suburb of Port-au-Prince.
The team followed a combined orthopedic/plastic surgery approach to managing severe limb injuries. The focus was on avoiding amputation whenever possible. A rotating staff of five plastic surgeons, five orthopedic surgeons, and five anesthetists, supported by traveling and local nurses, performed the operations. During the 10 week trip, 348 operations were performed on 148 patients—an average of 47 surgeries per week.
Most of the patients had severe crush injuries, and were sent to the hospital for surgery after initial evaluation elsewhere. The orthopedic surgeons used bone manipulation and fixation techniques to repair and reconstruct fractures and other bony injuries. The plastic surgeons used skin grafts and other techniques to reconstruct the skin cover and blood supply to the injured limbs.
Most of the orthopedic operations were carried out in the first few weeks. The need for general anesthesia also decreased, reflecting the decline in more complex operations as time went on. Overall, about three-fourths of the procedures were soft tissue procedures requiring the expertise of plastic surgeons.
Dr. Clover and colleagues believe their combined orthopedic/plastic surgery approach was highly successful in salvaging the severely injured limbs. Just four percent of patients eventually required amputation. Complications were infrequent and generally related to delays in medical care before arrival at the surgical hospital.
The experience highlights the ability of surgical specialists to execute a prompt and effective response to mass-casualty disasters like the Haitian earthquake. The high priority on preserving the injured limbs was due to the high disability associated with amputation in poor countries like Haiti where rehabilitation and prosthetic services aren't widely available. By focusing on limb salvage, their goal was to mitigate the long-term human and economic consequences of limb loss.
"This experience shows that a favorable amputation rate can be achieved, and the changes in work load over time demonstrate the benefit that an ortho- plastic limb salvage team can provide in the early stage of disaster relief," Dr. Clover and coauthors conclude. They also emphasize the need for the quickest possible response, in order to have appropriate surgical expertise manage the initial influx of acute injuries. The organizers are creating lists of needed equipment and supplies, as well as surgeons and other medical professionals available to respond to future disasters.
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