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Plastic Surgery during Natural Disasters: Lessons from Haiti

2010; Lippincott Williams & Wilkins; Volume: 126; Issue: 2 Linguagem: Inglês

10.1097/prs.0b013e3181df7255

1529-4242

Anup Patel, Matthew McRae, Mark McRae, Indranil Sinha, John Persing,

Bone fractures and treatments

Sir: The media coverage of the tragic earthquake in Haiti has focused on the ability of general, trauma, and orthopedic surgeons and neurosurgeons to address many of the health issues following a natural disaster.1 Certainly, these specialties play a vital role in the relief effort. Despite the active stance of the American Society of Plastic Surgeons in facilitating the deployment of plastic surgeons during natural disasters, there has been little, if any, media discussion on the role of the plastic surgeon in treating the injured of Haiti.2 Media coverage per se is not the desired end, but rather the recognition within the medical community and disaster relief efforts that plastic surgeons play a significant role in the management of complex wounds and their rehabilitation. This is becoming belatedly obvious in military war injuries. To be sure, images of people trapped under giant pieces of rubble tend to be associated with damage to internal organs or skeletal fractures that are treated by surgeons outside of plastic surgery. However, by including plastic surgeons into the relief effort planning, it would likely prevent many potentially unnecessary amputations by means of reconstruction of the soft-tissue and skeletal defects.3 Understandably, highly complex operations are difficult, or impossible, to perform in resource-constrained settings, but nonetheless the diverse skills of the plastic surgeon will permit, at the very least, the heightened surgical management of open extremity wounds and craniofacial trauma. More specifically, Thakar et al. recently highlighted the various roles a plastic surgeon can play in disaster relief, from salvaging limbs with free flaps to burn management with tissue rearrangement. However, this seems to be omitted from any of the discussion in the medical needs of Haiti.4 This proves especially worrisome because if disaster agencies such as UNICEF and the Red Cross cannot be made aware of the utility of plastic surgeons during these times, then how can they be expected to incorporate the specialty in future disasters. Therefore, we must take responsibility to educate those outside of plastic surgery on its ability to correct a diverse range of diseases, both elective and emergent. Equally important, we should develop rapid response teams that would be willing and able to participate on short notice in these disaster help efforts. The American Society of Plastic Surgeons has already initiated the steps to do this, listing on its Web site an e-mail address on signing up to become a volunteer in Haiti and organizations to which financial contributions can be made.2 During natural disasters, there can be greater emphasis on activation of “rapid response teams” that can triage patients to appropriate specialists including plastic surgeons and can expedite the mobilization of medical supplies. This could potentially increase the efficacy and efficiency of outside surgical teams to aid patients of a natural disaster.5 Volunteers should sign up to maximize efforts organized by plastic surgery. Perhaps, as we mobilize our effort in Haiti, the therapeutic options plastic surgeons can offer during this natural disaster will improve relief workers' knowledge on when to call on the specialty for assistance. Anup Patel, M.D., M.B.A. Matthew Mcrae, M.D. Mark Mcrae, M.D. Indranil Sinha, M.D. John Persing, M.D. Section of Plastic and Reconstructive Surgery Yale University School of Medicine New Haven, Conn.