By Stephen J. Mathes
Medical Atlas of muscle flaps.
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Extra resources for Clinical Atlas of Muscle and Musculocutaneous Flaps
In the interim, when planning services, it is important to be realistic as to how and where they may be best placed within the current healthcare system. There are, however, some basic principles that need to be considered and these are discussed below. 9 Principles for planning service provision As with preventive activities, the following principles should be adapted to address specific issues relating to particular problems of individual countries or its regions. The Addis Ababa Fistula Hospital has recently published a paper on its experience of setting up a fistula centre which may provide helpful information for health services planners considering establishing such a facility (10).
In cases where the bleeding, is not arterial, a firm vaginal pack should be used. In cases of arterial bleeding the woman should be taken to the operating theatre and the bleeding points identified and ligated. Should bleeding continue, other causes should be sought. She will need her Hb levels checked if her bleeding has been severe, and any resulting anaemia treated by iron supplementation. Catheter blockage Blockage of a catheter requires immediate attention in order to relieve pressure on the surgical repair site.
These should then be presented in order of each woman’s arrival at the clinic for the doctor to see. The outpatient examination A nurse or a nurse’s aid should accompany the woman into the examination room and gently show her to a chair near the examining doctor where a brief medical history is taken. She should, if possible, stay with the woman throughout her examination and the subsequent discussions. The medical history will be followed by a physical examination that may, or may not, include a pelvic examination, depending on the doctor’s preference.