A British doctor volunteering in DR Congo used text message instructions from a colleague to perform a life-saving amputation on a boy.
Vascular surgeon David Nott helped the 16-year-old while working 24-hour shifts with medical charity Medecins Sans Frontieres (MSF) in Rutshuru.
The boy's left arm had been ripped off and was badly infected and gangrenous.
Mr Nott, 52, from London, had never performed the operation but followed instructions from a colleague who had.
The surgeon, who is based at Charing Cross Hospital in west London, said: "He was dying. He had about two or three days to live when I saw him."
Careful instructions
It is not clear how the boy was injured. It was suggested that he had been bitten by a hippopotamus while fishing, but Mr Nott also heard that he had been caught in crossfire between government and rebel forces.
There were just 6in (15cm) of the boy's arm remaining, much of the surrounding muscle had died and there was little skin to fold over the wound.
Mr Nott knew he needed to perform a forequarter amputation, requiring removal of the collar bone and shoulder blade.
He contacted Professor Meirion Thomas, from London's Royal Marsden Hospital, who had performed the operation before.
"I texted him and he texted back step by step instructions on how to do it," he said.
"Even then I had to think long and hard about whether it was right to leave a young boy with only one arm in the middle of this fighting.
"But in the end he would have died without it so I took a deep breath and followed the instructions to the letter.
"I knew exactly what my colleague meant because we have operated together many times."
The operation is only performed about 10 times a year in the UK, usually on cancer patients, and requires the back-up of an intensive-care unit. Patients usually lose a lot of blood during the procedure.
Mr Nott, from Fulham, west London, had just one pint of blood and an elementary operating theatre, but the operation, performed in October, was a success and the teenager made a full recovery.
The surgeon, who volunteers with MSF for a month every year, said: "I don't think there's more than two or three surgeons in the UK who can do this. It was just luck that I was there and could do it.
"I don't think that someone that wasn't a vascular surgeon would have been able to deal with the large blood vessels involved. That is why I volunteer myself so often, I love being able to save someone's life."
In the absence of intensive-care facilities, Mr Nott said he had personally monitored the boy's recovery from his bedside, tending his wounds.
"It was touch and go whether he would make it so when I saw his face on the MSF website afterwards, it was a real delight," he added.
Is their some kind of award this guy would qualify for? Doing something that's apparently so difficult in such a situation is beyond remarkable.
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That is pretty damn cool. I have a small amount of faith in pre-meds now... some of them might become that skilled...
Then again, any doctor that works in those conditions is probably going to be pretty awesome just from practice. Especially if they are trained in a western country.
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While the untrained can successfully perform a simple amputation of, say, a hand or lower arm, I don't think the untrained could do this one. Too many very large blood vessels, complicated removal of collar and shoulder bones without damage to rib cage or torso muscles, and the difficulty of closing the wound all require excellent and trained skills.
I suspect the youth of the patient was also a major factor in survival and recovery.
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Solauren wrote:Impressive. Not unheard of (Doctor's getting or giving instruction via communication device), but still impressive.
I wonder if this would have been as successful if the amputator had not been a trained doctor?
To further Broomstick's point:
The surgeon wrote:I don't think that someone that wasn't a vascular surgeon would have been able to deal with the large blood vessels involved.
Not only would a non-surgeon not have had a hope in hell of doing this, neither would the vast majority of fully trained surgeons. There were too many big blood vessels involved, and nowhere near enough blood on hand to save the lad had anything gone wrong.
