By Mass Communication Specialist 1st Class Todd J. Hack Naval Medical Center San Diego Public Affairs
SAN DIEGO – Six Naval Medical Center San Diego (NMCSD) physicians traveled to Hanoi, Vietnam in mid-August as a follow-up to Pacific Partnership 2012 (PP12).
Capt. (Dr.) Craig Salt, staff Plastic Surgeon, Capt. (Dr.) Eric Hofmeister, Orthopaedics and Navy Orthopaedic Specialty Leader, Cmdr. (Dr.) Peter Shumaker, chairman, Dermatology and Cmdr. (Dr.) Douglas Winstanley, Dermatology, were on the team that worked alongside Vietnamese doctors to treat burn victims at the National Institute of Burns (NIB) from Aug. 14-28, 2013. According to the U.S. Embassy press release, the recent activity was the second phase of the multi-phase “Vietnam Interventional Burn Management Subject Matter Expert Exchange” supported by U.S. Pacific Fleet.
PP12 represented the fourth time in five years the annual mission visited Vietnam to conduct humanitarian and civic assistance. In concept, this most recent exchange served as a bridge to future missions, fostering long-term personal and professional relationships with the host nation to increase cooperation in a variety of areas.
Shumaker became the team lead, based partly on his experiences as mission dermatologist during PP10 and a pilot laser scar treatment program initiated during PP12. Phase I took place for two weeks in April beginning with the Asia Pacific Burn Congress in Hanoi, Vietnam.
In April, the NMCSD team participated in extensive hands-on and formal didactic exchange at the National Institute of Burns in Hanoi and advanced planning was made for Phase II in August to be a success.
“When I was there in April, we screened approximately 50 patients for future treatment, which included both surgical procedures and laser therapy. During the follow on mission in August we performed surgery and dermatology performed laser treatments on those patients as well as many others,” said Salt. “Dermatology also re-treated a few of the patients that they had treated during previous phases. We have seen progressive improvements in these patients.”
An ablative fractional carbon dioxide laser, the same type currently used at NMCSD for wounded, ill and injured rehabilitation and used previously by medical experts aboard the hospital ship USNS Mercy (T-AH 19) during PP12, was applied to help remodel restrictive scars and improve patients’ quality of life using innovative techniques. The majority of consumable supplies were purchased via NMCSD using Pacific Fleet funds to facilitate the exchange.
“We treated 26 patients during Phase I and 45 patients during Phase II, including a dozen or so treatments. Among these was a 3-year-old patient first treated with the laser aboard USNS Mercy in 2012, shortly after her discharge from the National Institute of Burns with debilitating scars more than 70% over her body,” said Shumaker. “She was treated with the laser again during Phase I and received both laser and surgery during Phase II. Undoubtedly she is walking and functioning much better than she would have without treatment and this serves as a great example of the potential benefits of long-term cooperation.”
At the NIB, patients primarily had burn injuries and many were severe, including extensive cosmetic disfigurement and disability, as well as limited ability to walk and use their arms and hands.
“The core of the exchange involved two breakthrough techniques that our doctors have applied for wounded warrior rehabilitation, including laser scar remodeling and staged surgeries using synthetic skin substitute,” said Shumaker.
Salt and Hofmeister combined their efforts for 14 surgical cases.
“We treated late burn wound contractures with a combination of Z-plasty and tissue rearrangement procedures, skin grafting, and staged reconstruction using a dermal substitute,” said Salt.
Many burn patients required more than one procedure.
“All of the cases involved contractures due to scar tissue and joint contractures. During the 14 surgeries, we treated 20 extremities due to several patients having more than one limb that needed care,” said Hofmeister. “Additionally, at the time of surgery, most of these patients also had laser treatments under the same general anesthesia.”
Phase II also included formal didactic exchange, a press conference, and an official meeting with Vietnam Ministry of Defense Military Medical Department Director Army Maj. Gen. Vu Quoc Binh. A separate pulmonary team, consisting of Capt. (Dr.) J. Scott Parrish and Cmdr. (Dr.) Greg Matwiyoff, Pulmonary and Critical Care, provided support activities and hosted an intensive seminar for Vietnamese physicians.
“We actually worked primarily with Plastic Surgeons from the Department of Plastic and Reconstructive Surgery at the NIB. The Pulmonary team members carried on exchange in parallel, including an intensive three-day seminar,” said Shumaker. “We conducted both large and small group didactic presentations at the NIB, but the exchange was primarily performed as a part of hands-on patient treatments.”
Communication barriers between physicians and local non-physicians, was one of the challenges the NMCSD team faced at NIB.
“The biggest obstacle from the first phase in April initially was building trust and respect with their physicians,” said Hofmeister. “Another obstacle that Pacific Fleet assisted with was providing personal protective equipment, surgical gowns and gloves, as the host hospital in Hanoi did not routinely have our sizes.”
Each hurdle they overcame provided a new way to experience each other’s culture and to learn.
“Working with the local Vietnamese surgeons was pleasant, educational, and rewarding,” said Salt. “I and several of my colleagues gave educational lectures and we also learned much from the local surgeons. In particular, I gained experience with their creative use of advanced scar release procedures. Additionally, the lead surgeon at the burn institute taught us about a revolutionary new microsurgical procedure, which he helped devise, to reconstruct neck contractures.”
In addition to healing burn victims, the collaboration between the NMCSD team and the NIB physicians provided medical advancements for both nations.
“The Vietnamese surgeons we worked with were well-trained and experienced. While the core of the exchange were advanced laser and surgical procedures that we have employed here in the rehabilitation of our wounded warriors, the facilities and the experience of our hosts were well-suited to high-level exchange as envisioned,” said Shumaker. “Furthermore, NMCSD does not have an integrated burn center so it was an excellent opportunity to gain experience with dozens of burn patients.”
Phase III involves hosting a group of Vietnamese physicians at NMCSD this December. Among other things, they are scheduled to attend NMCSD's 4th Annual Project C.A.R.E. (Comprehensive Aesthetic Restorative Effort) training summit Dec. 4-8, 2013, a multi-disciplinary event dedicated to the advancement of wounded, ill and injured service members.
“While we don't have any immediate plans to return (to Vietnam), we are very interested in continuing long-term engagement and building on the excellent foundation of the current project,” said Shumaker. “This model is promising as a sustainable platform for continued high-level exchange in a wide variety of disciplines.”
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