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New Zealand Medical Services in Middle East and Italy
Surgical Treatment During the Battle of Alamein
Surgical Treatment During the Battle of Alamein
With regard to the actual surgical treatment of the different types of wound there was no radical alteration, but there was a more thorough carrying-out of established techniques and a better documentation of the cases.
The New Zealand style of Tobruk plaster fixation in the Thomas splint was now standardised. The use of plaster bandages to bandage the arm to the body in cases of fracture of the humerus was a definite improvement at this period. Instructions had been given to pad and splint all forward plasters, but this was not satisfactorily carried out. The insertion of a rubber tube while applying the plaster facilitated the subsequent cutting.
page 399Head cases during the Alamein battle were all evacuated to the base neurosurgical unit in Cairo.
Facio-maxillary cases were evacuated to the base units. Dentists attached to the CCS were utilised for the treatment of fractured jaws.
Sucking chest wounds were dealt with by excision of the wound and tamponage with a vaseline pack stitched loosely to the skin.
In abdominal cases difficulty arose in dealing with many late cases. Colonel Donald, British consultant surgeon to the forward areas, introduced at that time a small suprapubic exploration incision in doubtful cases to ascertain whether there was blood in the pelvis, a sign of intra-abdominal injury. Exteriorisation of the colon had become standardised. The retention of abdominal cases in the forward operating unit following operation had become the routine.
Amputations were frequently performed following the severe mine injuries. It was in these cases particularly that blood transfusions proved invaluable. They were dealt with conservatively, and site-of-election operations were no longer performed. Severe sepsis had been noted in traumatic amputations which had not had thorough wound excision.
Knee joints: A solution of sulphathiazole in oil was being utilised for injection into these joints at operation. The patella was being completely excised in compound fractures by many surgeons.
Anaerobic Infection: In the forward areas serious gas infection was uncommon, apart from a gangrene supervening on the destruction of the main vascular supply of the limb. Occasionally, in large wounds of the buttock, thigh, or deltoid, the muscle was involved to some degree but free local excision proved quite satisfactory. The presence of gas in the tissues was often noted without serious infection or toxaemia. Only the rarest cases required amputation, and that generally when the blood supply of the limb was seriously interfered with.
Sulphonamides: The dusting of a fine coating of sulphanilamide powder on the wound had become universal. Sulphathiazole was given intravenously in cases of anaerobic infection and intra-abdominally in abdominal wounds. Sulphadiazine was given to abdominal and head cases. For abdominal cases it was introduced by tube to the infected area for the first forty-eight hours. In head cases it was given intravenously in cases with dural perforation. Sulphonamide by mouth was given by routine to every wounded man, the dosage being noted either on the AF 3118 or on a special slip.
Serums: ATS was given as a routine. Anti-gas serum was given in cases of anaerobic infection or of gross muscle injury.
page 400Blood Transfusion: The organisation of blood transfusion units had led to what was at the Battle of Alamein a well-nigh perfect result. Blood was made available in very large quantities to all forward units and the supply was kept up from the base, from which it was sent forward by transport planes. The normal dose of blood given was two pints, but sometimes much more was required. Serum was less often indicated, and glucose saline was utilised freely for continuous transfusions in abdominal cases.