….need perseverance!
When I came to Muheza in July, one of the things they were keen
for me to establish on my return is mesh inguinal hernia repair. Currently a
suture repair is performed here, a technique we rarely use now in the UK. Unfortunately,
whilst the benefits are very well described, the cost of the mesh is prohibitive
in low resource environments. Quite remarkably, a clever technique emerged in
India a few years ago using sterilised mosquito net as a surrogate implant. I
heard about this at a conference a while back when the results of Project Hernia
(a UK charity that sends regular surgical missions to Africa) was presented.
Over the last few months I had made contact with Project Hernia who were
incredibly helpful, sending me supporting literature, protocols for sterilisation
as well as a consignment of net (mesh)!
Keen to get things going, I had prepared some samples to
autoclave one evening. I took them to theatres in their suggested postal envelopes,
explained the precise protocol and went for lunch whilst they ‘cooked’….. on my
return they were waiting and I opened them up eagerly….
 |
| The top is the original size, the three samples (bottom) have horribly shrivelled. |
…disaster. They had melted, coming out like little shrunken
crisp packets that had been cooked in the oven as part of a Blue Peter Badge project.
The mesh has a melting point of 122°C and so it is crucial that
the machine is set to 121°C to ensure sterilisation whilst maintain the integrity
(it is supposed to shrink a little). It turns out that the autoclave machine
here only runs at 135°C and they only have one machine (the other is broken) –
this is a major issue. Gutting. Almost heart-breaking to be honest. All that preparation….We
have agreed to ask the hospital engineer whether we can adjust the machine
easily, but I suspect not and that another solution will be required…..hmmm....
Back home, Kate went in with Beth to school today for the morning
which was a genius move by my amazing wife. She helped Beth to interact with
the other children and from the big smile on little Beth’s face today, it is a
massive step in the right direction.
Could you use cotton mosquito netting which might withstand 135degC?
ReplyDeleteOr maybe could you use a pressure cooker as an autoclave for the plastic stuff? In a sealed pressure cooker, the boiling point of water increases as the pressure rises, resulting in superheated water. At a pressure of 1 bar or approximately 15 psi (pounds per square inch) above the existing atmospheric pressure, water in a pressure cooker will reach a temperature of 121 °C (250 °F).