News & Stories
The Ritual of Healing II
The Ritual of Healing II
In The Field
22 February 2017
Avanell Brock is a CUREkids Coordinator and photographer at the CURE Malawi Hospital. One of her duties is to take photos of the kids’ surgeries.
Warning: There is blood in some of the following images.
Almost a year ago, I posted a photo essay about my experiences in the operating room. At the time, I’d only been at CURE for a couple months, and I didn’t have a lot of surgeries under my belt. So, here’s a continuation of that post with some of the more interesting surgeries I’ve seen over the past year. I have developed a fascination with the skin grafting and plastic surgery processes. In my previous post, I wrote more about the mystery and beauty of surgery as a ritual, something that I didn’t completely understand and was amazed by.
This photo essay explains the process of some of the surgeries that still fascinate me. I understand the process and how it works a lot better than I did a year ago, but it’s still amazing to me to see how God created the human body to heal, and how doctors have used their knowledge of that healing process to do things I wouldn’t think possible in order to correct deformities.
Syndactyly: Release and full thickness skin graft
Syndactyly is a condition where fingers or toes become fused together, typically in utero (in the womb). Felista is a young girl with bilateral syndactyly, which is where the first three fingers of both hands were born connected. Dr. Linda uses a marker to plan out where the different flaps of skin will go on Felista’s hand, so they can use as small a skin graft as possible.
Dr. Linda specializes in doing hands and is pretty consistently called in for the more difficult operations. I love photographing her glasses!
The skin is cut in a sort of zigzag fashion, so when the fingers are separated, the triangles can be pulled across and into place. Then, they are stitched to the other side of the finger.
Due to the risk of losing blood supply to the fingers, only two adjacent fingers can be separated at one time. After her fingers are healed, the other two fingers will be separated. This means Felista will have at least 3 more operations to separate all of her fingers.
Dr. Linda stitches on bits of a skin graft taken from Felista’s stomach. Since the space between the fingers is missing, they need to take extra skin from somewhere else. Usually, the skin is taken from the abdomen, leg, or upper arm.
Neglected clubfoot: Frames
Clubfoot is a common disability that is easily treated in infancy with the Ponseti casting method. In most industrialized nations, the condition is dealt with at birth and no one would ever know a child was born with clubfoot. In Malawi, the lack of treatment means kids like Fatima often reach maturity with a severe deformity that can only be treated with intensive surgery, and often, frames.
CURE is a training hospital and, sometimes, there are more residents in the room than doctors! Inyas, Tongai, and Scott all watch and learn about frames from Dr. James and Dr. Lubega.
Wires are drilled through the foot and leg at various angles to help hold the frame in place. The frame is slowly manipulated by turning the struts slowly each day, which moves the foot into the correct position over the course of several weeks. Putting on one frame takes a very long time, usually between 2-3 hours. Fortunately, Fatima had only one clubfoot. Most of the time, the condition is bilateral, which makes for a very long operation!
Lawrence’s clubfoot reoccurred after his treatment wasn’t completed a few years prior. His foot was so stiff that a frame was necessary.
Dr. James picked out a great scrub cap for Lawrence’s surgery! We commented on it, and he said that he didn’t even notice!
A bandage is wrapped around the frame to protect it right after surgery.
Burn contracture: Abdominal flap
Bridget’s hand was severely burned when she was younger. The burn and scar tissue pulled the back of her hand together and her fingers up so that she couldn’t use them. In this image, Dr. Lubega holds the hand up and squeezes it before a tourniquet is placed.
First, the scar tissue needs to be removed from the back of the hand.
Dr. Lubega hard at work.
With the scar tissue completely removed, the hand can be closed.
Often, if the area of flesh on the back of the hand is too large and thick for a skin graft, the surgeons will do a stomach or abdominal flap. This is a “bridge,” which is cut into the skin on the stomach. The hand is inserted under the “bridge,” and the skin is stitched over the hand. Since the blood supply is coming from both the hand and the stomach, it heals faster and allows for a thicker graft. After two weeks, the hand is detached from the stomach, and the two ends of the bridge are stitched closed. A patient cannot feel someone else simultaneously touching their stomach and their hand. The nerve endings take a long time to heal and connect.
Originally posted at: https://avanell.wordpress.com/2017/01/19/the-ritual-of-healing-ii/