gms | German Medical Science

60. Kongress der Deutschen Gesellschaft für Handchirurgie

Deutsche Gesellschaft für Handchirurgie

08. bis 10. Oktober 2020, Münster

What to do if there is no doctor? Offering paediatric handsurgery with Doctors Without Borders in Monrovia, Liberia

Meeting Abstract

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  • corresponding author presenting/speaker Stefan Krieger - Ärzte ohne Grenzen Deutschland, Praxisklinik Orthopädie Uniklinik Franziskus Aachen, Sektion Extremitätenchirurgie, Aachen, Germany

Deutsche Gesellschaft für Handchirurgie. 60. Kongress der Deutschen Gesellschaft für Handchirurgie. Münster, 08.-10.10.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. Doc20dgh44

doi: 10.3205/20dgh44, urn:nbn:de:0183-20dgh445

Published: October 9, 2020

© 2020 Krieger.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: How to provide competent,sustainable and appropriate surgical treatment to burn contractures and congenital malformations in children in a low resource setting?

Method: The sole childrens’ hospital of Liberia is based in Monrovia. It is operated by Doctors without Borders (MSF). Due to a lack of resources in the health sector, Liberia has no means to respond to the high need of hand treatment of sequelae of burns, trauma and congenital malformations. Since 2019, MSF offers for four weeks per year handsurgical treatment within specialized camps. The pilot camp's results are presented.

Results: First, the facilities of the OT and the surgical equipment's were adjusted to handsurgical quality criteria. A physiotherapist was recruited to ensure postoperative handtherapy. In the local media a campaign was launched to sensitize the population and detect children with dysfunctional hands.

In the clinic, 102 children were examined, 60 of these presented an indication for surgery. The vast majority of these suffered from extensive burn contractures. Most affected functional disabilities were detected in hands, followed by elbow, shoulder, lower extremities and face. Congenital disorders of the hand (e.g. thumb duplication, syndactylie or polydactylie) were common. Long surgeries, with higher risks of complications, were done in the beginning of the camp in order to safeguard the postoperative period by the surgeon.

During the pilot camp, 37 out of the 60 patients in need were treated by 41 operations. Two patients we operated on both hands. Two cases required a follow-up operation due to infection. The surgery included: contracture releases of hands, joints and face by skin plasties with or without skin graft or regional flap, thumb reconstructions, resection in polydactylie and separation of syndactylie. Early postoperative results were very satisfying in improving substantially the function of hands, joints and eye lids in ectropium.

After discharge, in surgical postoperative consultations all patients were seen by the handsurgeon. Further surgical follow-up and physiotherapy was guaranteed in the hospital.

Conclusion: During the pilot camp promising results with substantial functional improvement after handsurgery in children in a low resource setting were achieved. Therefore regular handsurgical camps are planned by MSF. Hereby experienced handsurgeons will invest in systematic capacity building of the national staff in order to safeguard the results of the treatment and quality of care.