gms | German Medical Science

Objectives/Interrogation: Since decades the Gazastrip suffers continuously from outbreaks of acute war violence within a chronic conflict setting. Acute or chronic sequelae of hand- and burntrauma are omnipresent and deteriorates the victim's social life substantially. As an international NGO we provide since 1998 hand and burnsurgical treatment. Our aim is twofold: (1) on the individual level, the victim's ability to participate in the social life should be improved through adequate handsurgical treatment, and (2) a sustainable optimization of the handsurgical support should be achieved by investing in continuous handsurgical capacity building.

Methods: International hand - and plastic surgical teams and anesthetists with broad experience in child anesthesia were continuously providing support. Operations and postoperative treatment were undertaken either in inflatable OT tents or in a hospital setting. Postoperative physiotherapy was ensured by qualified local personnel. Supervision and training of the local surgeons was integrated in the daily routine.

Results and Conclusions: In acute war phases, handsurgery is secondary. During post-war and chronic conflict periods, handsurgical interventions became predominant. In 2015 in total 390 operations in hand - and burnsurgery were performed. Contracture release was done by low risk procedures like skin graft, local or fasciocutaneous flaps. Separation of syndactylie was performed, treatment of complex dysmelia, amelia or macrodaytylie is too resource demanding in the given context. Gunshot lesions of the radial nerve with persisting motoric deficit were treated by tendon transposition, those of the ulnar or median nerve by nerve interposition and/or tendon transposition. 2500 burn patients were treated with 35000 sessions of physiotherapy. 50 % did heal without functional sequelae, and a participation in their social life was achieved. In total, 39 % of all patients were younger than 5 years.

Hand- and burnsurgery are essentially in the portfolio of the humanitarian surgery in chronic conflicts. Offering handsurgical treatment has the potential of social life saving surgery, especially for children. Training of local personel assures sustainability of qualified care. Preconditions for offering continuous support and capacity building are: acceptable security conditions, availability of experienced international handsurgical and anesthetic personnel and qualified physiotherapy.