Secondary Intent

When I first got to Haiti I saw mostly traumatic emergencies, but the patient demographic has changed since then. The greatest need now is orthopedics, and that will also change. Currently one of the biggest health risks is the lack of proper wound care, and this will continue to be a serious concern for months to come. I have personnal experience treating open wounds, and a lot of my time in Haiti was spent teaching how to treat wounds. Several that I saw were already too infected or necrotic for tissue salvage and required amputation, but others just needed debriding and regular care. Outside of Haiti many of these wounds could be grafted and closed in short order, but the only realistic option for many thousands in Haiti is to let the wounds heal by secondary intent. This is a medical term that describes the body's ability to grow it's own tissue. The proper treatment for many of these wounds is simple, and can be done at home with little education and minimal supplies. The patient does not need to return to a hospital everyday for treatment and this would save considerable time and resources. I am preparing to initiate an intervention of supplies and education directly addressing the treatment of open wounds. The following is a brief synopsis of one treatment regimen. First, assess for infection and treat if necessary, prophylax open fractures as indicated. Clean and debride the area, apply gauze to those areas with at least some subcutaneous tissue remaining. If only the muscle layer remains, closure will not occur without expeditious surgical intervention. Although the use of Dakins solution has recently lost favor, it is nonetheless cheap and effective. Wet the gauze with a clorox bleach solution, and dress. The dressing should be removed regularly, preferably every 24hrs, and removed dry to stimulate granulation tissue. Smaller laceration type wounds should be kept clean and antibiotic ointment can be used if available. If supplies are limited, I would suggest dressing intervals no greater than 48-72 hrs. Eventually, many of these wounds will close by secondary intent. Some will still need surgical intervention in the future, but until then, this regimen will keep the wounds sterile and reduce the total area reqiring definitive closure. At this time I am seeking logistical support and supplies for a return trip to Haiti. I am available anytime for consultation. The best way to contact me is by email jozdad6@yahoo.com. Sincerely, Dr Grant Schmidt