ASJ Anniversary

19 THE GLEANER | SUNDAY, MARCH 3, 2019 A N INNOVATIVEmethodof treating infected non-unions of bones was born in the Siberian town of Kurgan, USSR in early 1950s by Professor GavriilIlizarov. The principle of the IlizarovMethod to treat large bone defects without bone grafts, utilised the bone’s ability to formnewbone (regenerate bone) duringgradual distraction using wires, rings and rods, a process known as Distraction Osteogenesis. This unique method is used to treat congenital, developmental and acquireddeformities, alongwith reconstruc- tion of large bone and soft tissue defects and complex fractures. The Ilizarov Technique was introduced into Jamaica in 1998. The greatest challenge was that of obtaining funding for the equipment. Ninety-nine percent of patients who required this specialised treatment are public patients, and many have difficulties obtaining funds to pay for their surgeries at the University Hospital of the West Indies (UHWI). The finan- cial constraints of the UHWI over the past years resulted, understandably, in the fundingofmore urgently needed equipment. Financial assistance was therefore sought fromthe private sector.This annual financial assistance began in 2003 andhas continued until 2017. All public patients received the use of the Ilizarov Circular Fixator free of cost. The impact of this uniquemethodof treatment can be measured in the following ways: SALVAGE OF LIMBS Trauma from gunshot wounds, motorbike and vehicle accidents continue to be prevalent in Jamaica, and often results in extensive open wounds with complex fractures. Some of these wounds become infected and fail to heal. Young males fromthe lower socio-economic communi- ties are usually the victims of this type of trauma. The problems in infected non-unions include: multiple draining sinuses, infected bone, bone and soft tissue loss, joint stiffness, com- plex deformities, limb-length inequalities and multiresistantinfection. Prior to the introduction of the specialised surgery in Jamaica, patientswith the above problems were poorly treated, with many of them being left with deformed, short, and chronically infected limbs. In some patients, amputationswere performedbecause of inability to control the infection as well as in those with significant limb-length discrepancies. These extremely challenging cases are always managed by the Orthopaedic and Plastic and Reconstructive Services at the UHWI. Non-union, infection,shorteninganddeformityarealladdressed simultaneously by the Ilizarov Technique. The limbs of a large number of patients have been saved by this unique method of treatment combined with usually extensive soft tissue coverage. RESTORATION OF EQUAL LIMB LENGTH Limb length discrepancies in children are secondary to congenital and developmental ab- normalities as well as growth plate injuries. The discrepancies can be as great as 8cm to 10cm. Limb inequalities in excess of 3cm can only be satisfactorily addressed by lengthening of the limb. Similarly, adults with large bone defects secondary to trauma or tumour have had their limbs restored by the same method. CORRECTION OF LIMB DEFORMITY Lower limb deformities when present in children and adults require correction (straight- ening of the limbs). Failure to correct the deformity will result in damage to part of the joint, usually the knee joint. These deformities such as Blount’s in children are best corrected using the Ilizarov technique with a circular frame. At the UHWI, over the past 17 years, approximately 700 patients have been suc- cessfully treated. The most dramatic progress in orthopaedic surgery in the last two decades has been in the field of deformity correction and patients in Jamaica and other Caribbean islands have benefitted greatly from this revolutionary method of treatment. Dr R E C Rose Consultant and Former Head Orthopaedic Surgery University Hospital of theWest Indies Development of specialised surgery IN SAN Diego, California, in the summer of 1992, August to be exact, Dr Clive Thomas, a consultant general surgeon practising at the Kingston Public Hospital (KPH) met up with Dr James ‘Butch’ Rosser, and dis- cussions were first held regarding lapa- roscopic surgery and the need for these procedures to be introduced to Jamaica. Rosser agreed with Thomas that Jamaica should not be left behind, and from that moment, the seed was planted. The seed, however, needed nutrition to grow, and on his return to the island Dr Thomas approached Dr Trevor McCartney, who, at the time, was not only the head of surgery, but also the senior medical officer and chief executive officer of the KPH. A proposal was hatched to introduce lapa- roscopic surgery into Jamaica with Rosser being the tutor to spearhead the initiative. Thomas made contact with Ethicon Latin America and the Caribbean in order to source equipment for the inaugural train- ing session as well as start-up equipment to get laparoscopy off the ground across the island, and they obliged. They donated equipment, which included disposables and three laparoscopic towers. At the same time, Dr Ronald DuQuesnay, programme director of the DM Post- Graduate General Surgery Programme and collectively, along with McCartney and Thomas, believed that The University of the West Indies might be the most appropriate location to have the teaching course. It was organised to be held at the Old Library, and all qualified surgeons across the island were invited to participate free of cost. The programme was developed by Thomas and Rosser and comprised a dex- terity course, which involved the use of laparoscopic instruments to remove the skin off of chicken breasts (provided by Jamaica Broilers). This was then followed by actual lap- aroscopic cholecystectomies (removal of the gallbladder) performed on actual (anaesthesised) pigs. The animal laboratory was set up after consultation with theVeterinary Unit of the Ministry of Health. The pigs were procured by the surgeons that were being trained. The course was a huge success, and this signified the start of a new era. Prior to James departure from Jamaica, laparoscopic operations were commenced at both The University Hospital and the KPH. The equipment used to conduct the course was donated to both hospitals as a gesture of goodwill in order to enhance the surgical development of this new skill across the country. As we look back over the 25 years since the introduction of laparoscopic chole- cystectomies to Jamaica, it is so apparent that thousands of patients have benefitted, and the private hospitals have embarked on providing this method of surgeryfor their patients. We now have advanced laparoscopic surgery available. Nissen’s Fundoplication and repair of hiatus (diaphragmatic) hernia, bariatric surgery, colectomies, appendectomies, splenectomies, pros- tatectomies, nephrectomies, and hepatic (liver) resections are now being performed laparoscopically in many hospitals across Jamaica. We are eternally grateful for the unselfish philanthropic efforts and gesture of Dr James Rosser Jr. He has made such an impact on the practice of medicine in Jamaica. Our residents in training have benefited tremendously, and several of our DM (Doctor of Medicine) graduates have done fellowships abroad to improve their skills and have returned to give the knowledge and expertise to our people. Contributions from: Dr Clive Thomas Consultant Surgeon Past President Association of Surgeons in Jamaica Dr Trevor McCartney Former Senior Medical Officer Kingston Public Hospital Laparoscopic surgery in Jamaica ASSOCIATION OF SURGEONS IN JAMAICA 60TH ANNIV SARY FEATURE: THE SUNDAY GLEANER MAGAZINE | MARCH 3, 2019