title: Traumatic near amputation secondary to hippopotamus attack: lessons for surgeons.
abstract: A 34-y-old man presented to Naivasha District Hospital (NDH) in Naivasha Town, Kenya, with near-complete below-knee amputation and hemorrhage after a hippopotamus attack. Residents from the University of Washington (UW), Departments of Surgery, Anesthesia, and Medicine, were rotating at NDH with the Clinical Education Partnership Initiative, a joint venture of UW and University of Nairobi. These providers met the patient in the operating theater. The leg was mangled with severely traumatized soft tissues and tibia-fibula fractures. The visiting UW Surgery resident (R3) and an NDH medical officer (second-year house officer) performed emergency below-knee completion amputation--the first time either had performed this operation. The three major vessel groups were identified and ligated. Sufficient gastrocnemius and soleus were preserved for future stump construction. The wound was washed out, packed with betadine-soaked gauze, and wrapped in an elasticized bandage. Broad-spectrum antibiotics were initiated. Unfortunately, the patient suffered infection and was revised above the knee. After a prolonged course, the patient recovered well and was discharged home. NDH house officers and UW trainees collaborated successfully in an emergency and conducted the postoperative care of a patient with a serious and challenging injury. Their experience highlights the importance of preparedness, command of surgical basics, humility, learning from mistakes, the expertise of others, a digitally connected surgical community, and the role of surgery in global health. These lessons will be increasingly pertinent as surgical training programs create opportunities for their residents to work in developing countries; many of these lessons are equally applicable to surgical practice in the developed world.
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington; Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Surgical Outcomes Research Center (SORCE), Department of Surgery, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington. Electronic address: ftdrake@u.washington.edu.
authors.forename: Frederick Thurston
authors.initials: FT
authors.lastname: Drake
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington; Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Elina
authors.initials: E
authors.lastname: Quiroga
authors.affiliation: Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Department of Surgery, Naivasha District Hospital, Ministry of Health, Republic of Kenya, Naivasha Town, Kenya.
authors.forename: Hazel W
authors.initials: HW
authors.lastname: Kariuki
authors.affiliation: Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Department of Surgery, Naivasha District Hospital, Ministry of Health, Republic of Kenya, Naivasha Town, Kenya.
authors.forename: Kizito A
authors.initials: KA
authors.lastname: Shisanya
authors.affiliation: Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Department of Anesthesia, University of Washington, Seattle, Washington.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Hotchkiss
authors.affiliation: Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Aliza
authors.initials: A
authors.lastname: Monroe-Wise
authors.affiliation: Bienville Orthopaedic Specialists, Ocean Springs, Mississippi.
authors.forename: John K
authors.initials: JK
authors.lastname: Drake
authors.affiliation: Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Naivasha District Hospital, Ministry of Health, Republic of Kenya, Naivasha Town, Kenya.
authors.forename: Joseph
authors.initials: J
authors.lastname: Mburu
authors.affiliation: Clinical Education Partnership Initiative (CEPI), University of Washington, Seattle, Washington and University of Nairobi, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, Washington; Bienville Orthopaedic Specialists, Ocean Springs, Mississippi; Department of Epidemiology, University of Washington, Seattle, Washington.
authors.forename: Carey
authors.initials: C
authors.lastname: Farquhar
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center (SORCE), Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D000673:Amputation, Traumatic / Q000601:surgery*; D000818:Animals; D001188:Artiodactyla; D003906:Developing Countries; D006801:Humans; D007391:International Cooperation; D007630:Kenya; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D013530:Surgical Wound Infection / Q000601:surgery*
keywords: Global health; Preparedness; Surgical education; Surgical training; Traumatic amputation