Tag Archives: surgical mission

Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Debridement and External Fixation for Bilateral Neglected Open Tibial Shaft Fractures

Debridement and External Fixation for Bilateral Neglected Open Tibial Shaft Fractures
Donald L. Fejfar, MD1; Nikhil Gattu, MD1; Ridwan M. Saeed, MD2; Hizkyas Kassaye, MD3; Bitiel Banda, MD4; Pierre M. Woolley, MD5; Kiran J. Agarwal-Harding, MD, MPH1,6
1Harvard Global Orthopaedics Collaborative, Boston, MA
2Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
3Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
4Mzuzu Central Hospital, Mzuzu, Malawi
5Hôpital Universitaire La Paix, Port au Prince, Haiti
6Beth Israel Deaconess Medical Center, Boston, MA

Open tibial shaft fractures represent a significant clinical challenge, particularly when presentation is delayed and wounds have become infected. This case demonstrates the surgical management of bilateral neglected open tibial shaft fractures in a young adult male who presented three weeks after initial injury from a motor vehicle collision in rural Malawi. He also suffered a bimalleolar fracture of the left ankle. The patient had grossly contaminated wounds with exposed bone and signs of infection bilaterally. The key procedural steps included aggressive irrigation and debridement of necrotic and infected tissue, skeletal stabilization with external fixation, local antibiotic therapy with gentamicin-impregnated collagen pellets, and soft tissue coverage with primary wound closure and a rotational subcutaneous flap on the left leg. External fixation is an essential treatment modality for open fractures with severe soft tissue injury when internal fracture fixation is not possible, especially in delayed cases with early signs of infection. This allows for staged management, repeated wound access, and preservation of blood supply while providing adequate stability for bone healing and soft tissue rest. This technique is particularly valuable in resource-limited settings where staged reconstruction and damage control orthopaedics are essential. The bilateral nature of these injuries, prolonged contamination period, immunocompromised status, and need for complex soft tissue reconstruction make this case unique and highlight the principles of managing neglected open fractures in challenging clinical circumstances.

Global Surgery, Print Release, Urology

PUBLISHED: Scrotal Hydrocelectomy Made Simple During a Surgical Mission

Scrotal Hydrocelectomy Made Simple During a Surgical Mission
Jaymie Ang Henry, MD, MPH1; Lissa Henson, MD2; Domingo Alvear, MD3
1Florida Atlantic University, G4 Alliance
2Philippine Society of Pediatric Surgeons
3World Surgical Foundation

A hydrocele is a condition characterized by the abnormal accumulation of serous fluid between the layers of the tunica vaginalis in the scrotum. While most hydroceles are typically asymptomatic or subclinical, larger ones can cause discomfort, heaviness, and cosmetic concerns. The surgical management of hydroceles aims to alleviate symptoms, improve cosmetic appearance, and prevent potential complications associated with untreated hydroceles, such as testicular ischemia or chronic pain.

This video highlights the surgeon’s expertise and attention to detail, ensuring a thorough and meticulous surgical technique. The step-by-step approach and clear communication with the surgical team facilitate a smooth and efficient procedure. The importance of this surgical technique extends beyond the individual patient. Providing a simplified and effective treatment option for hydroceles has the potential to improve patient outcomes and reduce the burden on healthcare systems, particularly in resource-limited settings or during surgical missions. Overall, the video serves as a valuable educational resource for surgical trainees and practitioners, demonstrating a simplified and effective approach to the treatment of scrotal hydroceles.

Global Surgery, Hand Surgery, Orthopedics, Pediatrics, Print Release

PUBLISHED: Bilateral Syndactyly Release of Third and Fourth Fingers

Bilateral Syndactyly Release of Third and Fourth Fingers
Sudhir B. Rao, MD1; Mark N. Perlmutter, MS, MD, FICS, FAANOS2; Arya S. Rao3; Grant Darner4
1Big Rapids Orthopaedics
2Carolina Regional Orthopaedics
3Columbia University
4Duke University School of Medicine

Amniotic band syndrome, or constriction ring syndrome, happens when a developing fetus gets tangled in the fibrous bands of the amniotic sac. Sometimes, fingers and toes can become trapped in these fibrous bands, with results ranging from amputation of the digits, to fusion of the fingers or toes, termed syndactyly. Syndactyly is amongst the most frequent congenital hand anomaly and is termed simple when the digits are connected by soft tissue only, and complex when one or more phalanges are fused. In complicated syndactyly, there are additional bony elements in between the digits making it challenging if not impossible to separate safely.

The patient in this case is a 1-year-old male with complex syndactyly of the left hand and simple syndactyly of the right hand. Here, both sides are released, with the left side involving a full-thickness skin graft taken from the patient’s groin crease. This case was filmed during a surgical mission with the World Surgical Foundation in Honduras.

General Surgery, Global Surgery, Pediatrics, Print Release

PUBLISHED: Right Inguinal Hernia Repair on a 1-Year-Old Boy During a Surgical Mission

Right Inguinal Hernia Repair on a 1-Year-Old Boy During a Surgical Mission
Yoko Young Sang, MD1; Domingo Alvear, MD2;
1Louisiana State University Shreveport
2World Surgical Foundation

This comprehensive video is intended to provide a detailed overview of the surgical technique used to repair a right inguinal hernia in Honduras on a 1-year-old boy who presented with a swelling in his scrotum, which had been present since he was two months old. The surgical procedure is narrated by an experienced pediatric surgeon, highlighting the unique challenges and innovative techniques employed in this case, which can be valuable for surgeons facing similar situations. The importance of this video lies in its educational value for surgeons, particularly those involved in surgical missions or practicing in resource-limited settings.

Fundamentals, Global Surgery, Print Release

PUBLISHED: Aspiration of Ganglion Cyst on Right Wrist

Aspiration of Ganglion Cyst on Right Wrist
Jonathan E. Sledd1; Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES2
1Edward Via College of Osteopathic Medicine – Auburn Campus
2Philippine Children’s Medical Center

Ganglion cysts are sacs containing a gel-like fluid that can form over tendons and joints. They are commonly seen as visible lumps on the hand and back of the wrist. Ganglion cysts are not cancerous, and most are asymptomatic. But if a cyst puts pressure on a nerve, it can cause pain, tingling, and muscle weakness. Initial treatment of a ganglion cyst is not surgical. Observation may be recommended because half of ganglion cysts may disappear over time. Activity often causes the cyst to increase in size, and thus immobilization may be an option. If a ganglion cyst causes pain and limits activities, aspiration of the fluid may decrease pressure and relieve pain. Surgical excision may also be recommended if symptoms are not relieved or if the cyst recurs. This article presents the case of a 51-year-old female who had a ganglion cyst on her right wrist. Treatment options were presented to the patient, and she opted to undergo aspiration over excision.

General Surgery, Global Surgery, Pediatrics, Print Release

PUBLISHED: Open Proctocolectomy for Hirschsprung’s Disease

Open Proctocolectomy for Hirschsprung’s Disease
Mudassir Shah Akhter, MD1; Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES2
1Oregon Health and Science University
2Philippine Children’s Medical Center

Hirschsprung’s disease is the main genetic cause of functional intestinal obstruction. Most cases are diagnosed in the first few months of life given classical presentation and ease of testing with rectal suction biopsy. The disease is due to the absence of enteric ganglion cells in the distal colon that results in functional constipation. Resection of the affected segment and bringing the normal bowel close to the anus has been the mainstay of treatment. Due to advances in surgical treatment over the past decades, a significant reduction in morbidity and mortality has been observed, and the previously multistage procedure can now be completed in one stage, as presented here.

Global Surgery, Hand Surgery, Orthopedics, Preprint Release

PREPRINT RELEASE: Bone Graft for Non-Union of Right Thumb Proximal Phalanx Fracture


Bone Graft for Non-Union of Right Thumb Proximal Phalanx Fracture
Hospital Leonardo Martinez, Honduras

Sudhir B. Rao, MD
Big Rapids Orthopaedics

Mark N. Perlmutter, MS, MD, FICS, FAANOS
Carolina Regional Orthopaedics

The patient in this case is an 11-year-old female who fractured the thumb of her dominant hand 1 year ago and now has a well-established non-union of the head of the proximal phalanx of her right thumb. Here, Dr. Rao and Dr. Perlmutter repair the fracture by harvesting a bone graft from the patient’s iliac crest and transplanting it into the fracture site. This case was performed during a surgical mission in Honduras with the World Surgical Foundation.

Announcement, General Surgery, Global Surgery, Preprint Release, Urology

PREPRINT RELEASE: Bilateral Simple Hydrocelectomy and Removal of Subdermal Implants


Bilateral Simple Hydrocelectomy and Removal of Subdermal Implants
Romblon Provincial Hospital

Domingo Alvear, MD
Founder, World Surgical Foundation

Lissa Henson, MD
Philippine Society of Pediatric Surgeons

Jaymie Ang Henry, MD, MPH
Florida Atlantic University, G4 Alliance

In this case, Dr. Alvear perform a bilateral simple hydrocelectomy and removal of subdermal implants while on a surgical mission in the Philippines. The diagnosis of hydrocele had been confirmed via ultrasound following transillumination during the physical exam.