The Surgical Problem
It is important to understand the nature of the injuries sustained by the victims and the following pages show some of those whom I treated.
PLEASE NOTE THIS SECTION CONTAINS GRAPHIC IMAGES THAT MAY UPSET SOME INDIVIDUALS AND ARE NOT GENERALLY SUITABLE FOR CHILDREN.
Please leave this section if you are a minor or are sensitive to such images. Please contact Mr Saeed for information about these procedures.
EARTHQUAKE VICTIMS
Danesh
Age approx. 10y
I found Danesh in the crowded corridor of the University Hospital. He had been waiting for days for treatment along with many hundreds of other patients.
His surviving family thrust x-rays into my hands and pleaded with me to help him.
Danesh’s hands were crushed by a large piece of masonry and helpers had to pull hard to extricate him from the rubble. The bones were fractured, the skin was stripped off and he was waiting for a planned amputation of both his hands. He was terrified.
At surgery it was clear to me that his hands were salvageable. Although he had multiple fractures and loss of skin the basic units of the hand - the tendons, nerves and bones were present. I restored the skin to the space between the thumb and his index finger using a distant flap from his groin. The conditions available did not support microsurgery as an option as it requires sophisticated, expensive facilities and experienced specialist in-patient nursing. I repaired the fractures and grafted the remaining areas of skin loss.
My plastic surgical colleague, Col. Mamoon of the Pakistan Army kindly took over his care in his own specialist unit and with his help both Danesh’s hands were salvaged.
His progress was reported in The Independent newspaper on 24 November 2005.
EARTHQUAKE VICTIMS
Kulsoom 
Kulsoom was also awaiting amputation of her hand. She had lost her little, ring and middle fingers and there was simply not the expertise to heal the wound. It was clear to me that her hand had a functioning thumb and index finger and as such would infinitely more useful than an amputation stump. repaired the fractures that were present and carried out a skin cover procedure. Kulsoom’s hand was salvaged.
EARTHQUAKE VICTIMS
Asad
Asad is lucky to be alive. A local surgeon asked me to look at him before I left Pakistan at the end of my first trip. He was at the military hospital and although I had visited this hospital, the volume of work where I was based prevented me from operating at this site. Our practice was to transfer patients over to our site if they needed specialist input. My plan that evening was to say my goodbyes and hand over aftercare instructions for some patients that I had treated to colleagues I had got to know and trust at the military hospital.
He had an exposed skull fracture, a fractured rib protruding out of a right chest wound, a large wound to his left arm and multiple fractures and tendon injuries to his right hand. These severe internal right hand injuries had not been noticed and someone had already sutured the wound.
There was no anaesthetist or operating list for Asad’s treatment that day. He was only a small child, had multiple wounds and was facing an amputation of his left arm and a crippled right arm. My opinion was that his limbs could be salvaged to a very functional level and all his other wounds closed with the right care.
I made my wishes known to Colonel Innayat, (Consultant Anaesthetist and Head of Theatres). The Colonel agreed to anaesthetise this patient himself and together we worked until 2am repairing the damage. Asad’s wounds healed and he did not require amputation.
Pre-op Final dressings.
Post-op, just waking.
EARTHQUAKE VICTIMS
Sajjad 10y
Sajjad’s case exemplified a disturbing aspect of treatment in these situations. Sajjad sustained an open fracture of his leg which was treated by an unknown surgeon. Instead of fixing the fracture directly, this surgeon inexplicably removed a large portion of the bone and replaced it with a rod of adjacent bone which was inappropriate in size and calibre. The wound was infected and open. Prospects were bleak for Sajjad because of the chronic infection (I treated Sajjad on December 5th 2005 on my second trip). He had no appetite, had lost weight and was suffering from intermittent high temperatures and malaise due to blood spread of the infection.
Over the course of a week and 3 operations, I cleaned out the infection. Our team gave him appropriate antibiotics and nutritional support. We encouraged his family to feed him as much as possible and him to eat as much as possible. When he was stronger I moved healthy muscle over his fracture site and in this way closed the wound. I handed his subsequent bone care to a competent local orthopaedic surgeon at the military hospital with whom I worked closely. He is making good progress.
There were many more patients with severe injuries. Patients with large areas that were unhealed, fractures open to the air, infected fractures; amputation stumps that were open, agonisingly painful, many of these were young children.
Over the period of two trips our team treated over one hundred patients surgically, Many of these were facing amputation.Wherever possible we passed on our knowledge to our Pakistani colleagues and indeed learnt from them.
Our team did not leave Pakistan on either of our relief trips without ensuring as best we could that all the patients treated had their aftercare organised.
Closing a buttock and back wound on a baby,
Typical limb wounds. Both children, both had thigh fractures.
A welcome cup of tea after a long day’s operating. Myself and Drs Samira, Ayub and Dilshad (left to right).
The evening ward round.
