Abstract
Introduction
Four weeks after the earthquake in Kashmir, multidisciplinary surgical teams were organised within the UK (MiST). The aim was to help with disaster victims who had been transferred to Rawalipindi. We reviewed the work carried by one such team from the 5-18 November 2005.
Patients
There were 78 patients: 50 lower limb injuries only, 21 upper limb, 7 combined, injuries. Mean age was 24 (0.5-80). 24 patients were under 10 and only 5 over 60. 274 procedures were performed over 11 days (average 25 per day).
Results
The majority of injuries involved 3B open injuries n=50 (64%) of which there were already 12 lower limb amputees before we arrived. 202 EUAs, washouts and debridements, 34 definitive orthopaedic procedures and 57 definitive plastic procedures were performed (19 combined procedures). The majority of wounds required multiple washouts prior to definitive procedures. Definitive orthopaedic procedures included 11 Taylor spatial frame fixation of long bone, 4 Ilizarov frames (9 of which required acute shortening), 5 ORIF long bones, 7 K wire fixation, 5 MUA, 2 Application of hip Spica. Definitive plastic procedures included 21 Split Skin Grafts, 4 amputations, 11 revision of amputations, 17 fasciocutaneous flaps (1 proximal based, 1 sural artery, 15 distally based) 3 musculocutaneous flaps (gastrocnemius, soleus and tensor Fascia lata) and 1 free flap (rectus).
Conclusion
There is a need for a multidisciplinary approach in the management of disaster trauma. This is essential in decision making regarding the management of bone and soft tissue injury, especially with regards to amputation.
The amputation rate was less than 1% (707 out of 120,000 injured) in the aftermath of the earthquake. The concern now is that the amputation rate may increase fourfold due to complications of the initial severe trauma and inadequacies of local healthcare.
