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Sundin John A. M.D.
Techniques in Orthopaedics: October 1995
Orthopaedic Lessons from Recent Wars: Articles: PDF Only


Since the end of the “cold” war, regional civil conflicts have increased and involved volunteer civilian surgical teams working with limited resources and basic equipment in fragile infrastructures. The scenario of conflict in Rwanda during the months of April to July, 1994 was typical of recent regional conflicts when the International Committee of the Red Cross established a surgical field hospital in Kigali, Rwanda. During the two-month period from May 2 to July 2, 1994, a single surgical team with one general surgeon performed 596 cases with 95% related to war wounds. The triage of the wounded into priority groups when the facilities and resources are limited is essential. The mechanism of injury and body site were mostly shell fragments (58%) and the limbs (62%), respectively. Ketaminc was the ancsthestic agent in 48% of the cases. The caseload included wound excision with delayed primary closure (44%), laparotomy (16%), fracture management (11%), and amputations (10%) as well as chest drains, craniofacial reconstructions, skin grafts, and enucleations. War surgery can be performed by a general surgeon without onward referral by applying sound surgical principles even when resources are limited.

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