Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg Hospital, Cape Town, 7505, South Africa.
Medical Department, Operational Center Brussels, Médecins Sans Frontières, Brussels, Belgium.
World J Surg. 2021 Apr;45(4):1021-1025. doi: 10.1007/s00268-020-05905-4. Epub 2021 Jan 15.
Populations at risk during humanitarian crises can suffer traumatic injuries or have medical conditions that result in the need for limb amputation (LA). The objectives of this study were to describe the indications for and associations with LA during and after humanitarian crises in surgical projects supported by Médecins Sans Frontières (MSF).
MSF-Operational Center Brussels data from January 1, 2008, to December 31, 2017, were analyzed. Surgical projects were classified into (annual) periods of crises and post-crises. Indications were classified into trauma (intentional and unintentional) and non-trauma (medical). Associations with LA were also reported.
MSF-OCB performed 936 amputations in 17 countries over the 10-year study period. 706 (75%) patients were male and the median age was 27 years (interquartile range 17-41 years). Six hundred and twenty-one (66%) LA were performed during crisis periods, 501 (53%) during conflict and 119 (13%) post-natural disaster. There were 316 (34%) LA in post-crisis periods. Overall, trauma was the predominant indication (n = 756, 81%) and accounted for significantly more LA (n = 577, 94%) in crisis compared to post-crisis periods (n = 179, 57%) (p < 0.001).
Our study suggests that populations at risk for humanitarian crises are still vulnerable to traumatic LA. Appropriate operative and post-operative LA management in the humanitarian setting must be provided, including rehabilitation and options for prosthetic devices.
在人道主义危机中，处于危险中的人群可能会遭受创伤性损伤，或患有需要截肢的疾病。本研究的目的是描述在无国界医生组织（MSF）支持的外科项目中，在人道主义危机期间和之后进行截肢的原因和与截肢相关的因素。
分析了无国界医生组织布鲁塞尔行动中心 2008 年 1 月 1 日至 2017 年 12 月 31 日的数据。将外科项目分为危机期和危机后期（每年）。将适应症分为创伤（有意和无意）和非创伤（医疗）。还报告了与 LA 相关的因素。
在 10 年的研究期间，无国界医生组织 OCB 在 17 个国家进行了 936 例截肢。706 名患者为男性，中位年龄为 27 岁（四分位距 17-41 岁）。621 例（66%）LA 是在危机期间进行的，501 例（53%）是在冲突期间进行的，119 例（13%）是在自然灾害后进行的。在危机后时期有 316 例（34%）LA。总体而言，创伤是主要的适应症（n=756，81%），在危机期间进行的 LA 明显多于危机后时期（n=179，57%）（p<0.001）。
我们的研究表明，处于人道主义危机风险中的人群仍然容易受到创伤性 LA 的影响。必须在人道主义环境中提供适当的手术和术后 LA 管理，包括康复和假肢装置的选择。
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