HUMANITARIAN MISSION OF PLASTIC SURGERY SERVICE ONE YEAR EXPERIENCE FROM MILITARY HOSPITAL TO CAMP ZAATARI: ABOUT 1643 CASES

Ghita Belmaati Cherkaoui, Sara Lahsaini, Abdenacer Moussaoui and Mohamed amine Ennouhi Reconstructive and Plastic Surgery Unit, Military Hospital of Moulay Ismail, Meknes Morocco. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 15 January 2020 Final Accepted: 17 February 2020 Published: March 2020


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The aim of thisworkis to shareourexperience, to review the services provided by plastic surgeons duringthis mission, the difficulties of practicingsurgery in thiscontext in patients who are victims of war and disaster, and to show the usefulness of this type of mission to encourage plastic surgeons to participate.

Materials and Methods:-
This workis a retrospectivestudy, in whichweused consultation and patient records thatweremanagedbetweenSeptember 2012 and September 2013. For each record, the following data wereused: 1. Age 2. Sex 3. Socio-economiclevel 4. Reason for consultation 5. Type of intervention 6. Type of anaesthesia Records not found, or incomplete, wereexcluded.

Results:-
The pathologies presented in thischapter are only a preview of the workwecarried out on the mission.
The use of data from the consultation and hospitalizationregisters for plastic surgery made it possible to identify 1643 cases, soweclassified the pathologies into four main groups:burns came at the top of the list (1341 cases seen in the acute stage and 82 cases of sequelae), woundsurgery and loss of substances were the second reason for consultation (154 cases), surgery of skin tumors and soft parts (47 cases), and finallybedsores (6 cases) ( Table 1). From time to time, we have had to face familydramaswithsevereburnsinvolvingseveralmembers of the samefamily. The burning of plastic tents (82% thermal burns) was the main cause. The burned area did not exceed 15% in most cases (922 patients) and the lowerlimbswere the mostaffected (359 patients) ( Figure 1.2) withpredominance of 2nd degreesuperficialburns (63%), whileonly 0.5% had 3rd degreeburns.
Given the context, the treatment of these pathologies consisted of local care, surgicaltreatment by skin graftswascarried out on 7 patients, then the patients werereferred to specialized structures in the Jordanian capital.

Surgery for wounds and loss of substance:
It representednearly 9.37% of ouractivity, the circumstances of occurrence are brawls and aggression (13%). Tribal conflicts, poverty, and poorhousing conditions are the main factors at the origin of this violence. 27.2% of the woundswere due to explosions and 21.4% to ballistic trauma (Table 2).

Skin tumors:
Theyaccounted for 2.86% of cases. In the majority of cases, these are benigntumours and a few malignanttumours (basal cellcarcinoma) electivelyinvolving the scalp. The treatmentwas an excision in all patients.

bedsores:
Our seriesincluded 6 patients. Most of the patients wereparaplegics. The meanagewas 29 years, withextremesrangingfrom 21 to 45 yearsold, predominantly male (sex ratio M/F=2). Three patients hadischialbedsores, two sacral bedsores and one heel sore. Theybenefitedfrom local trimming and care. The management of this type of patients revealsratheradapted, evenspecialized structures.

Discussion:-
This type of experience tends to overturneverythingwetake for granted or obvious in ourdailylives. The reflectionis about the usefulness of such a commitment for the population beingtreated;itis about the political and economicuniverse of the host country whichisoften the cause of the mission; itis about an ethicalsurgical attitude and the quality of the workdone.

Plastic surgery in a precarioussituation?
It's the practice of reconstructive surgery in difficult situations. It is more commonlycalled "humanitarian plastic surgery".
It ischaracterizedby: a new and difficultenvironment, a precarious place of practice, particular pathologies encountered, and the application of all the fields of plastic surgery (hand surgery, treatment of burns and theirsequelae, traumatologicalsequelae, maxillofacialsurgery, etc...) [3].

Target population?
Missions are offered to all patients in countries or institutions thatrequestthem. The teams try to treat patients in all fields of plastic surgery or they focus their mission on a specificpathology. The aimremains to treat patients who, in any case, wouldnever have had the opportunity to accesssuch care in their country [3].
For our mission itwas a fragile population, whichmovedfrom the southern provinces of Syria (Deraa and Homs) to the north of Jordan. Unfortunately, and as is the case in all disasters and armedconflicts, the living conditions of theserefugeesweredeplorable (promiscuity, lack of hygiene...).

The drill site?
It isoftenprecariousboth by the actual conditions of exercise (poorlyperforming operating room, frequent power cuts, etc...) and by the progress of the mission (massive influx of patients, delayed care, unprepared patients, etc...).
Our humanitarian mission took place at the Moroccanfieldhospital in the Zaatari camp, the only structure to ensure a medical permanence in the camp.
It is a hugeexpanse of tents and mobile homes, in the centre of a vastarid and stony plain in northern Jordan, a few kilometresfrom the Syrian border.

The composition of the teams?
It variesaccording to the missions. A mission caninclude a single surgeon if the structure hostingitalready has the surgicalenvironment for the operations. Conversely, a mission canbecomposed of a complete team to becompletelyautonomous [3].
For our mission, the ArmyHealth Service (SSA) was in charge of the planning and implementation of thishumanitarianoperation, determining the list of personnel supervised by the Chief MedicalOfficer. There was one plastic surgeon and one nurse experienced in plastic surgery care.

Principle of care ?
In precarious situations, the practice of plastic surgery must respect certain principles. Knipper has groupedthemtogetherunder the name "4F concept": [3] F for Feasibility: an operation must befeasibleunderprecarious conditions and by a single surgeon.