David Nott: Working in Aleppo

When Abdel Malek was brought into the emergency room in Aleppo in September 2014, his lower left leg was so badly damaged by fragments from a barrel bomb attack that the Syrian doctors thought they would have to amputate the little boy’s foot.

The doctors that remain in Aleppo are passionate and committed but did not have specialist training in vascular, orthopaedic, plastic or reconstructive surgery, understandably given how the war has halted their education and training. I took over the management of the case and was able to show them another way of treating the little boy which would also save his foot.

We took the tiny long saphenous vein from Abdel Malek’s right leg and did a bypass graft to the injured lower leg and foot. The next stage was a cross leg flap to cover the bypass graft.  Abdel Malek was kept in this position for three weeks, with his foot elevated and held in place with external fixators, to allow the flap to get its blood supply from the injured leg.

The flap was cut a month later and the legs separated. With the continuing care of the surgeons I trained, Abdel Malek’s foot healed and slowly and steadily, he started to walk again. I was overjoyed when my friends in Aleppo sent me a video on WhatsApp of Abdel Malek playing football with his friends. It demonstrated to me the power of surgery and the options it presents for reconstruction and recovery.

Moments like this were sadly very rare when I was in Syria in September – October 2014.  Indiscriminate bombing of civilian areas with grossly destructive barrel bombs – crude devices filled with TNT and shrapnel – caused the most injuries. Day after day, the emergency room and operating theatre were filled with innocent people blown to pieces by these crude devices.  Often all we could do was try to ease their pain.

Read the complete blog at: The Hippocratic Post

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