GUATEMALA: DAY SIX

Source: Blog Post

At the Moore Pediatric Center, our day started with our usual rounding. After plans were made for therapy and follow up for all the patients operated on from the previous day we then headed to the operating rooms.

The first case of the day was a patient with arthrogryposis with a 90 degree wrist flexion deformity and no active elbow flexion. We performed a tenotomy of the FCR and PL tendons, a dorsal closing carpal wedge ostectomy, and an ECU to ECRB/L tendon transfer for the wrist. For the elbow, a long head of triceps to biceps tendon transfer was performed. We fixated the triceps tendon onto the ulna through a bone drill hole.

Another big case for the day was a thumb on-top plasty for a patient with amniotic bands. The patient had a very small nonfunctional index proximal phalanx along with an unstable thumb distal phalanx. We transferred the index proximal phalanx and part of the metacarpal over to the thumb metacarpal in order to provide a longer and stable thumb as well as a deeper 1st webspace.

As for the therapists, one team went to the Roosevelt burn hospital while another team went to El Von Ahn hospital. Patients were evaluated and treated at both hospitals. A third team stayed at the hotel and consulted with local therapists on various challenging cases. One of the biggest issues in Guatemala is prolonged immobilization which unfortunately leads to significant stiffness in many patients. Elsewhere, at at Chicoy Alto, the group continued their work on the road leading to the school.

April 18, 2018 Cases:

  1. Long head of triceps to biceps tendon transfer, dorsal carpal wedge excision, ECU to ECRB/L tendon transfer, and FCR/PL tenotomy – arthrogryposis
  2. Thumb on-top plasty – amniotic band
  3. 4th webspace simple syndactyly release 
  4. Trigger thumb release
  5. 1st webspace release (4 flap Z-plasty) – burn contracture
  6. Ulnar shortening osteotomy – Madelung’s deformity
  7. Bilateral polydactyly excision + simple syndactyly release
  8. Duplicate thumb excision/correction
  9. 1st webspace release (4 flap Z-plsty) + 3rd webspace simple syndactyly release
  10. Thumb burn contracture release, Z-plasty and skin grafting