Fessh deformity correction upper limb vr
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Transcript of Fessh deformity correction upper limb vr
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Managing severe hand deformities in Cambodia
V Rajaratnam, Senior Consultant Hand SurgeonKhoo Teck Puat Hospital, Singapore
W Lam, J K Yong, Keo V, J Gollogly
This work is licensed under a Creative Commons Attribution 4.0 International License.
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Aim: Developing a targeted surgical training programme for the
sustainable ,management of severe hand Deformities in CSC
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Methodology
Severe trauma
Severe burn contractures
Severe venomous injuries
• Community-oriented curriculum• Needs analysis of surgeons• Personalised programme• Targeted training • Feedback and Practice• Assessment• Evaluation of the programme
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Methods – Community-oriented Curriculum
DELIVER Curriculum (Pedagogy Specific to Cambodia)
Assessments INDEPENDENT PRACTICE & TEACH OTHERS
DESIGN Curriculum (around Training Needs)Targeted Competency Based
DISCERN Community NeedsVisiting Centre Plan Training Needs based on
Community Needs
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Discerning the Community Needs:A Compilation of 600 Cases (before visit)
Cases Percentage
Burns and trauma deformity 453 76%Congenital 142 23.2%
Nerve (not brachial plexus) 5 0.80%
Total 600 100%
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Designing the Curriculum TOPICS LEARNING PROCESS TIME
Basic Science Hand Assessment Workshop
6 mths
Deformity 1:Burn contractures
Flap design workshop
1-2 yrs
Deformity 2: Tendons Tendon workshop 6 mths
Deformity 3 Fracture and dislocations Osteomyelitis
Fracture fixation workshop
1 yr
Nerve 1: Paralysis, cerebral palsy and spasticity
Micronueral workshop
1-2 yrs
Nerve 2: Brachial plexus
Micronueral workshop
1-2 yrs
Congenital Hand Deformities Lectures, tutorials, supervised operating
2-3 yrs
✔
✔
✔
✔
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Learning needs analysis of surgeons1. Identify surgeon2. Assess skill level3. Develop personalized training program4. Show and Supervise5. Assess independent practice
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Selected Workshops Microneural Workshop Nov 2013
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Tendon Workshop May 2014
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Fracture Fixation Workshop May 2015
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English slides, but local language (Khmer)Live and Online
Information Technology Workshop Nov 2014
GoPro Camera
https://www.youtube.com/channel/UCbjUKspmSoIuOq2FUiPGt_g
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Personalised program
• Deformity assessment - CBD• Decision making and planning - CBD• Surgical option generation – Lectures, CBD• Selection/execution under supervision - DOP• Deliberate practice - DOPS• Independent performance/assessment - DOP
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Results: Management of Deformities
Cases Percentage
Burn and trauma deformity 36 40%
Congenital 18 18%Nerve Injuries 23 24%
Tumour 3 3%
Brachial Plexus 16 16%
Total: 96 100%
66%
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Results: Management of Deformities (59)
Burns
Paralyti
c Diso
rders
Ischemic
Contractu
re
Lace
rations
Snak
e Bites
Defects0
5
10
15
20
25
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Targeted Training principles: flaps and skin grafts
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The pedicled groin flap
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The reversed radial forearm flap
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Evaluation of the programme
BEFORE AFTER THE FUTURE
1.375 4.46 4.875
DEFORMITY
BEFORE AFTER THE FUTURE
1.625 4.41 4.5
CONGENITAL HANDS
BEFORE AFTER THE FUTURE
1.25 4.375 4.28
BRACHIAL PLEXUS INJURIES
Not confident Very confident
1 2 3 4 5
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Thank you