Clinic of Traumatology and Orthopaedics, Percy Military Hospital, Clamart, France.
Int Orthop. 2012 Oct;36(10):1989-93. doi: 10.1007/s00264-012-1548-z. Epub 2012 May 3.
Indications for amputation in natural disasters are not the same compared to our daily practice. They must be determined by those with great surgical experience and good knowledge of military or disaster surgical doctrine. Unfortunately, nowadays few surgeons have this experience. In fact, some volunteer surgeons may be interested in providing care for civilian victims of war or disaster in developing countries. However, there are significant differences between the type and the management of cases seen in this context versus those seen at home. The problems of amputations cannot be solved schematically. Amputation will depend on several factors: the form of warfare or disaster, the conditions for surgery, the skill of the surgical team and the experience of the surgeon, and the length or duration of the mission.
Here is a schematic showing the three main situations: civilian practice, war practice and disaster context. These three different situations require different strategies for treating the wounded and for making amputation decisions.
In the case of a natural disaster, there are many wounded civilians, they arrive at the medical facility late and there is usually only one surgeon and a single, limited medical facility to provide all treatment. He must make quick, wise choices, economising limited blood supplies and the use of surgical procedures. The decision to proceed with limb salvage or amputation for patients with severely injured limbs will be a source of continued debate. Amputation, radical and irreversible intervention, is a frequent and essential procedure in the disaster context and one of the standard means to successful treatment of limb wounds.
We propose to reflect on the following questions: why to amputate, how to perform amputation under these conditions and how to pass on a doctrine to the voluntary surgeons who lack experience in a disaster context.
与日常实践相比，自然灾害中的截肢指征有所不同。它们必须由具有丰富手术经验和良好军事或灾难外科理论知识的人来确定。不幸的是，如今很少有外科医生有这种经验。事实上，一些志愿外科医生可能有兴趣在发展中国家为战争或灾难的平民受害者提供医疗服务。然而，在这种情况下看到的病例类型和处理方式与在国内看到的有很大的不同。截肢问题不能按部就班地解决。截肢将取决于几个因素：战争或灾难的形式、手术条件、手术团队的技能和外科医生的经验，以及任务的长短或持续时间。
这里有一个示意图，展示了三种主要情况：平民实践、战争实践和灾难背景。这三种不同的情况需要不同的策略来治疗伤员和做出截肢决策。
在自然灾害的情况下，有许多受伤的平民，他们很晚才到达医疗设施，通常只有一名外科医生和一个单一的、有限的医疗设施来提供所有的治疗。他必须做出快速、明智的选择，节约有限的血液供应和手术程序的使用。对于严重受伤的肢体，决定进行保肢还是截肢将是一个持续争论的问题。截肢术，即激进和不可逆的干预，是灾难背景下常见且必不可少的程序，也是成功治疗肢体创伤的标准手段之一。
我们建议思考以下问题：为什么要截肢，如何在这些条件下进行截肢，以及如何向缺乏灾难背景经验的志愿外科医生传授这一理论。
