2007 Publications
-Traction for Adult Femoral Shaft Fractures: a Report on 53 patients in Sierra Leone.
-Surgical Services in Low-Income and Middle Income Countries.
-Rural Surgery in Southern Sudan.
Traction for Adult Femoral Shaft Fractures: a Report on 53 patients in Sierra Leone.
Gosselin R.A., Lavaly D.J. Perkins. Traction for Adult Femoral Shaft Fractures: a Report on 53 patients in Sierra Leone. International Orthopedics, 2007, Vol. 31, Issue 5, pp. 697-702.
Link: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2266653
Abstract
A retrospective study of 53 consecutive adult patients with 54 femoral shaft fractures treated with Perkins traction over a 25-month period was carried out. Mean length of stay was 52.1 days (range 25–108), and mean duration of traction was 45.0 days (range 23–66). At a mean follow-up of 4.6 months (range 3–9), 50 (92.6%) had healed and 5 (9.3%) had a malunion. There were 4 (7.4%) non-unions, 3 (5.5%) had shortening of more than 2.5 cm and 2 (3.7%) had a re-fracture. The rate of pin tract infection was very high at 42.6% (23 patients).
Surgical Services in Low-Income and Middle Income Countries.
Spiegel D.A., Gosselin R.A. Surgical Services in Low-Income and Middle Income Countries. The Lancet, 2007, Vol. 370, Issue 9592 pp. 1013-1015.
Link: http:// www.med.upenn.edu/globalhealth/documents/LancetSpiegel.pdf
Abstract
Although substantial progress has been made in addressing the burden of communicable and vaccine-preventable diseases in low-income and middle-income countries, the burden of diseases that are surgically treatable is increasing and has been neglected. Both morbidity and mortality from surgically preventable (eg, elective hernia repair) or treatable (eg, strangulated hernia) disorders can be greatly decreased through simple surgical interventions. Why should a child die from appendicitis, or a mother and child succumb to obstructed labour, when simple surgical procedures can save their lives?
Rural Surgery in Southern Sudan.
Contini S., Gosselin R.A. Rural Surgery in Southern Sudan. World Journal of Surgery, 2007, Vol. 31, Issue 3, pp. 613.
Link: http://www.springerlink.com/content/k3851127686754l2/?p=9722ddf63e694bc0a1433a1d7b5e4a71&pi=12
Abstract
This article reports a retrospective analysis of a 6-year experience of providing surgical care in remote areas of southern Sudan under extremely adverse conditions. Teams of expatriate consultants (surgeon, anesthetist, scrub nurse) carried out 28 “surgical missions” with the aims of treating surgical cases previously selected and of training local personnel in basic surgery on the job. A total of 1642 patients (71% males, 30% under the age of 16) have undergone an operation. Altogether, 1264 elective procedures (77%) and 378 emergency procedures (23%) were performed. Hernia surgery comprised the main workload, followed by proctologic and gynecologic operations. Most operations were performed under spinal anesthesia. Other cases required ketamine, and a small number of patients had local anesthesia. There were 14 fatal complications, most of them related to the delay in obtaining medical attention. Based on the training results, the Sudanese personnel of two of the five health centers involved in the program are already fully autonomous. Two doctors and two nurses are proficient in essential surgery; two not qualified nurses are proficient in “primary” anesthesia; and others are proficient in scrubbing and surgical nursing. This report demonstrates that it is feasible to establish surgical services in rural areas of developing countries by utilizing simple facilities, providing them with basic equipment, and employing local personnel selected and trained on the job by teams composed of a consultant surgeon, anesthetist, and scrub nurse. This seems to be the only realistic possibility for providing surgical care to the rural populations of the least developed countries.
