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Ortho-Plastic Limb Salvage in Haiti Earthquake: Analysis of Case-Load and Early Outcomes


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Emergency Surgery Workshop Davos 2011: Presentation by Barbara Jemec, MD, Plastic Surgeon, Royal Free Hospital and Chairman, Overseas Service and Training Committee for BAPRAS, London, UK

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Ortho-Plastic Limb Salvage in Haiti Earthquake: Analysis of Case-Load and Early Outcomes

  1. 1. Experience of an Ortho-Plastic Limb Salvage Team after the Haiti Earthquake: Analysis of Case-Load and Early Outcomes Barbara Jemec and James Clover On behalf of the BAPRAS MERLIN Emergency Response
  2. 4. The Response <ul><li>Joint Response </li></ul><ul><ul><li>The British Association of Plastic and Reconstructive and Aesthetic Surgeons (BAPRAS)and Medical Emergency Relief International (MERLIN) </li></ul></ul><ul><li>Concentrating on complex limb injury </li></ul><ul><li>Short Term Emergency Intervention </li></ul><ul><li>Surgical Team – </li></ul><ul><ul><li>2 Surgeons – 1 Plastic 1 Orthopaedic </li></ul></ul><ul><ul><li>2 Anaesthetists 3 Nurses </li></ul></ul>
  3. 7. Aims <ul><li>To evaluate the activity and early outcome of an ortho plastic limb salvage team </li></ul><ul><li>To see whether this intensive surgical response is justified by improved limb salvage rates </li></ul>
  4. 8. What was not treated
  5. 9. Brief Overview <ul><li>Log Book Data </li></ul><ul><li>Weeks 3 to 8 post earthquake </li></ul><ul><li>292 Operations on 119 patients </li></ul><ul><li>Over a 6 week period </li></ul><ul><ul><li>Av 48 cases/ week </li></ul></ul><ul><ul><li>Av 8 cases/ day </li></ul></ul><ul><ul><li>6 GA and 2 non GA </li></ul></ul>
  6. 10. Activity over Time
  7. 11. Anaesthetics
  8. 12. Activity by Speciality
  9. 16. Limb Salvage <ul><li>11% (18/158) of patients referred had complex limb defects </li></ul><ul><li>12/18 underwent successful limb reconstruction </li></ul><ul><li>4% Amputation Rate </li></ul><ul><ul><li>3 BKA, 1 AKA, 2 Digits </li></ul></ul><ul><li>10% operations dealing with the sequelae of amputations </li></ul><ul><ul><li>10 patients, 8 amputated elsewhere </li></ul></ul>
  10. 17. Complications Complications Number Death 1 Regrafting 7 (2 of these regrafted twice) SSG to flap 1 SSG failure needing delayed flap 1 Infection 4 Haematoma 1 Amputation for Failed salvage 2
  11. 18. Was it worth it? <ul><li>Limb Salvage Surgery is Possible and Beneficial in early response after earthquakes </li></ul>
  12. 19. Acknowledgments <ul><li>All the volunteers </li></ul><ul><li>MERLIN </li></ul><ul><li>BAPRAS </li></ul><ul><li>Department for International Development </li></ul><ul><li>Disasters Emergency Committee </li></ul><ul><li>Emergency Response Relief Fund (UNOCHA) </li></ul><ul><li>Swedish International Development Agency </li></ul>
  13. 20. Thank you