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East and Central African Journal of Surgery
Association of Surgeons of East Africa and College of Surgeons of East Central and Southern Africa
ISSN: 1024-297X
EISSN: 1024-297X
Vol. 20, No. 3, 2015, pp. 12-20
Bioline Code: js15045
Full paper language: English
Document type: Research Article
Document available free of charge

East and Central African Journal of Surgery, Vol. 20, No. 3, 2015, pp. 12-20

 en An Introduction to the New Online Journal club - ‘Surgery in Africa’, and First Summary of a Module - Compartment Syndrome and Diagnostic Tests
Kazuma, S.; Kaja, S.; Sakala, S.; Shinondo, P.; Kad, M.; Ngongola, A.; West, C.; Howard, A.; Aird, J. & Harrop, T.

Abstract

Background: Surgery In Africa (SIA) is a virtual journal club that stimulates Continuous Medical Education (CME) on up to date clinical information and an evidence based approach. SIA is for COSECSA trainees but publishes summaries of the modules to increase accessto CME, while also enabling trainees to gain experience at scientific writing.This summary is on Compartment Syndrome (CS).
Methods: Three expert selected articles were reviewed - A review paper, a researchpaper anda methods paper on critical appraisal of studies of a diagnostic test. Five senior African surgeons gave their opinions to stimulate the discussion forum.
Results: Trainees described personal challenging experiences of Compartment Syndrome. The application of best practice evidence from Europe and North America studies presented challenges. The reasons for this include the different causes such as snakebites, overuse of tight circumferential plaster casts and the patterns of disease (delayed referrals) that affect the sensitivity of Compartment Syndrome monitoring and decisions to perform fasciotomy. In snake bites, the underlying disease process is different and associated haematological changes also affect the harm/benefit of fasciotomy pressure monitoring. Infection risk is increased in settings with less sanitation. Misconceptions arose from the articles that were corrected: Intra-compartmental measurement of pressure does not have to be continuous, and where pressure monitoring devices are not available they can be self made. Research to assess a home-made device in African settings would be required. More research is also needed regarding the complications of fasciotomy performed for late presenting compartment syndrome.
Conclusions: It is important for surgeons to understand that it is not always easy to apply evidence collected in different resourced settings. It would be difficult to justify the use of invasive devices in resource constrained settings unless studies are conducted to prove their safety and efficacy

 
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