A Cadaver-Based Course for Humanitarian Surgery Improves Manual Skill in Powerless External Fixation

Coleman, Julia R.; Lin, Yihan; Shaw, Brian A.; Kuwayama, David P.

doi:10.1016/j.jss.2019.04.061

Cited by 4 publications

(7 citation statements)

References 20 publications

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“… HIC institutional support for surgical training in LMICS — either through support for the delivery an existing formal training programme [ 15 , 53 , 56 , 58 , 63 – 68 ], or additional training delivered to trainees enrolled in a formal training programme [ 17 , 18 , 48 , 69 – 71 ], or delivered outside of a formal training programme [ 16 , 19 – 21 , 61 , 72 – 77 ]. Provision of qualified HIC surgical care providers as trainers in LMICs [ 15 , 61 , 78 ], or the training of such HIC providers to work successfully in low resource environments [ 79 , 80 ]. …”

Section: Resultsmentioning

confidence: 99%

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Global Surgery Education and Training Programmes—a Scoping Review and Taxonomy

2021

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Global surgery is an emerging field of study and practice, aiming to respond to the worldwide unmet need for surgical care. As a relatively new concept, it is not clear that there is a common understanding of what constitutes “global surgery education and training”. This study examines the forms that global surgery education and training programmes and interventions take in practice, and proposes a classification scheme for such activities. A scoping review of published journal articles and internet websites was performed according to the PRISMA Extension for Scoping Review guidelines. PubMed MEDLINE, EMBASE and Google were searched for sources that described global surgery education and training programme. Only sources that explicitly referenced a named education programme, were surgical in nature, were international in nature, were self-described as “global surgery” and presented new information were included. Three hundred twenty-seven records were identified and 67 were ultimately included in the review. “Global surgery education and training” interventions described in the literature most commonly involved both a High-Income Country (HIC) institution and a Low- and Middle-Income Country (LMIC) institution. The literature suggests that significant current effort is directed towards academic global surgery programmes in HIC institutions and HIC surgical trainee placements in LMICs. Four categories and ten subcategories of global surgery education and training were identified. This paper provides a framework from which to study global surgery education and training. A clearer understanding of the forms that such interventions take may allow for more strategic decision making by actors in this field.

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Section: Resultsmentioning

confidence: 99%

“…Provision of qualified HIC surgical care providers as trainers in LMICs [ 15 , 61 , 78 ], or the training of such HIC providers to work successfully in low resource environments [ 79 , 80 ].…”

Section: Resultsmentioning

confidence: 99%

Global Surgery Education and Training Programmes—a Scoping Review and Taxonomy

2021

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“…This can be viewed as clinically relevant also, because a residual ER is much more functional as residual IR [33,34]. Nevertheless, the general surgical residency (nonorthopedic surgery) does not give a predisposition to achieve direct correct alignment, because only two teams (2/6) succeeded in realigning a leg after a 2-day course [1].…”

Section: Discussionmentioning

confidence: 99%

“…The problem of having a long bone fracture in hostile or uncommon and challenging environments is that traditional methods of fracture repair may not be feasible or effective due to various challenges. These challenges may include weightlessness, restricted resources, absence of healthcare facilities, difficulties in soft tissue and wound management, challenges in anesthesia administration, and, above all, limited access to surgical expertise [1]. Therefore, finding appropriate and effective methods for fracture repair in hostile environments is crucial to ensure successful healing, functional recovery, patient outcomes, and survival, while not compromising all other activities that depend on that injured person.…”

Section: Introductionmentioning

confidence: 99%

“…However, a major limitation in hostile environments is the restricted availability of trained surgeons to set up the fixator despite the huge need [1]. For example, more than 21% of the surgical activities of Médecins Sans Frontières (MSF) are orthopedic surgeries, including external fixators [1][2][3][4][5], but are not usually performed by a specialized surgeon. The fixator can decrease the rate of amputation and enhance limb salvage and life in humanitarian contexts [5].…”

Section: Introductionmentioning

confidence: 99%

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An Easy-To-Use External Fixator for All Hostile Environments, from Space to War Medicine: Is It Meant for Everyone’s Hands?

Manon,

Pletser,

Saint-Guillain

et al. 2023

JCM

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Long bone fractures in hostile environments pose unique challenges due to limited resources, restricted access to healthcare facilities, and absence of surgical expertise. While external fixation has shown promise, the availability of trained surgeons is limited, and the procedure may frighten unexperienced personnel. Therefore, an easy-to-use external fixator (EZExFix) that can be performed by nonsurgeon individuals could provide timely and life-saving treatment in hostile environments; however, its efficacy and accuracy remain to be demonstrated. This study tested the learning curve and surgical performance of nonsurgeon analog astronauts (n = 6) in managing tibial shaft fractures by the EZExFix during a simulated Mars inhabited mission, at the Mars Desert Research Station (Hanksville, UT, USA). The reduction was achievable in the different 3D axis, although rotational reductions were more challenging. Astronauts reached similar bone-to-bone contact compared to the surgical control, indicating potential for successful fracture healing. The learning curve was not significant within the limited timeframe of the study (N = 4 surgeries lasting <1 h), but the performance was similar to surgical control. The results of this study could have important implications for fracture treatment in challenging or hostile conditions on Earth, such as war or natural disaster zones, developing countries, or settings with limited resources.

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