Post provided by Marc DeHart, MD
Seems like the acute care mission of the big injuries is slowing down, and it’ll be good to hear Dr. Smoot’s thoughts as he returns from his week of caring for the Haitians. A big part of the surgical care so far has been amputating limbs that couldn’t heal or had infections that were threatening life. Like in war time, earthquakes take a major toll on vulnerable exposed parts like hands, arms, feet and legs. While the UN estimates over 250,000 Haitians have been injured, the best estimates of Handicap International include over 2000 amputations. Of course since the medical facilities have been wiped out, there is no infrastructure for prosthetics. Even with modern prosthetic legs in developed countries, the energy needed to walk increases. In a country where poor nutrition is common, any increase in energy needs compounds an already severe problem. As you might expect, the higher the amputation – the more energy that is required: near the heel ~ 15% more, below the knee (BKA or trans-tibial) ~ 25% more, and at the thigh level (above the knee, AKA, or trans-femoral) ~ 50% more energy required. It is interesting that walking with crutches takes more energy than a below the knee prosthesis.
Prosthetic legs can sometimes last less than two or three years, often require adjustments for fit and function, and require even more changes for children. A prosthetic leg in the US can cost over $2000-3,000, and expense that just won’t work with the economics for the Haiti population. Low cost techniques that are relatively easy to implement will be required to give as many limbs to allow a return to survival. Several designs for “3rd world” prosthetics have been developed with costs below $100 (see http://legsforall.com/projects/goals.php). The residual limbs (“stumps”) usually require 4 – 6 months to heal up and form a strong enough scar to allow final fitting of a new prosthetic limb. Using resources available in Haiti and teaching survivors of the earthquake how to build, fit, and modify prosthetic limbs will be a major need in the next 6 – 12 months.
With the significant changes that are going to have to happen after the earthquake, it may very well be that a hard working Haitian – with a prosthetic leg – will serve as a potent symbol of their rebuilding island nation.
Marc DeHart, MD