Honduras: Day Four

Source: Blog Post

Today we arrived at the hospital for yet another busy operative day. We ran the board of cases in the AM with the surgeons, anesthesiologists, and nurses and assigned roles for they day. We have found that communication, such as morning “board rounds” is critical to the success of outreach missions!

Today, I flipped between cases helping wherever I was needed in the room I was assigned. I was fortunate today to be working with a number of different attendings, doing some interesting cases.

I started the day with Dr. Fufa doing two second stage FDP tendon reconstruction for a patient who had Hunter rods placed by a previous Brigade. The patient had full passive motion preoperatively, which was fantastic. We harvested palmaris longus from the bilateral wrists and used them to reconstruct the tendons through bone tunnels drilled through the distal phalanx, and tied them over a button (since there were no buttons available, we made holes in caps of the Marcaine bottles and used them as buttons). The second case was a patient with a history of a one-bone forearm who had subsequently required a cement spacer for a planned Masquelet-technique reconstruction performed by a previous Brigade. We used iliac crest graft to fill the segmental defect. We were able to harvest enough graft to completely fill the defect. I was particularly impressed by the quality of the membrane that had formed around the spacer, which was very stout, and we were able to close it without difficulty.

The final case for me was a patient with a history of a distant shoulder dislocation and associated axillary nerve injury who had inability to abduct or externally rotate his shoulder. We indicated this patient for a latissimus transfer to infraspinatus to restore external rotation. I worked with Dr. Ruch for this case, meticulously dissecting out the neurovascular pedicle to the latisimus and identifying the relevant anatomy in the area prior to performing the transfer.

I have found this whole trip to be particularly rewarding on several levels, and today in particular was a great example of why.  From a surgical standpoint, we are able to provide much needed treatments for patients that would otherwise go untreated. From an educational perspective, I have been able to work with world-renowned surgeons treating complex, and often times, rare problems. And lastly, from a humanitarian perspective, I have been truly struck by the effort put in by everyone who was a part of the trip. Nobody has been above any task – Dr. Moran even scrubbed in at one point to close the crest graft site during our Masquelet case just to help move things along. Overall, I found this to be a particularly rewarding experience and hope to have the opportunity to continue to be a part of it in the future.