Issue of
December 1, 1999

Interplast's instructional CD to help surgeons in developing countries

BY KRISTIN WEIDENBACH

When volunteer medical teams with Interplast leave developing countries after their two-week visits to perform reconstructive surgeries in children, they typically leave behind happy patients and families, and newly trained local surgeons. Now, they're planning to leave behind something else -- instructional compact disks.

Interplast has a long and illustrious association with Stanford. In 1969 Don Laub, MD, then chief of reconstructive and plastic surgery, started the nonprofit group. Since then, Stanford volunteer teams have participated frequently and performed thousands of surgeries on Interplast missions. Now, Stanford plastic surgeon Mike Stephanides, MD, with a team of volunteers, has produced a CD that will teach surgeons how to do cleft lip and palate repairs -- the most common procedure performed by Interplast surgeons.

The CD is designed to be an adjunct to an Interplast visit, reinforcing techniques that the local surgeons have learned during the team's stay. "It is for doctors from developing countries who've done [the procedure] before," said Stephanides. "It is to give to [a surgeon] you've just finished doing a cleft lip with, so they can go through it again and again at their leisure."

The CD contains pictures and text that demonstrate the most widely used surgical techniques for cleft lip repairs. "We went to leaders in the field and distilled their knowledge into one place," said Kevin Montgomery, PhD, technical director of the Stanford-NASA National Biocomputation Center, one of the sponsors of the project.

Robert Pool, MD, wrote about the Pool unilateral cleft lip repair procedure that he pioneered; and Peter Randall, MD, described the unilateral Randall/Tennison repair that he and Charles Tennison developed. "We brought them here, sat down with them and picked their brains," said Stephanides, who is medical director of the biocompuation center.

Leslie Hovey, MD, provided photographs and text of the Millard repair, Richard Jobe, MD, covered the Davies repair and Stanford's Stephen Schendel, MD, professor and chair of functional restoration, described a French technique called the Delaire repair.

The disk also contains video of some procedures, illustrated descriptions of cleft palate repair techniques and examples of poor cleft lip repairs that can result in abnormal lip shape with suggested surgical remedies.

"Cleft lip repair is tricky," said Stephanides. It is important to correctly identify the anatomical landmarks of the normal lip, which are misaligned in a cleft lip, he explained. "In an infant we are talking about a tiny area where a one-millimeter error makes a difference in the surgical outcome," he added.

Statistically, a cleft lip or palate will occur in one of every 700 children born in the United States. The facial structures are formed from three bony plates that fuse in the middle of the face during fetal development. If the upper lip, sometimes including bone of the upper jaw, fails to fuse, the baby will be born with a cleft lip. A cleft palate is a split in the roof of the mouth that leaves a hole between the nose and mouth. Experts believe that hereditary factors are involved, but the ultimate cause of a cleft lip or palate is not well understood. Surgeons can begin operations to repair the cleft once the baby is eight to 10 weeks old.

The new Interplast CD includes a question and answer section for parents of a child born with a facial cleft. Geetha Palreddy, MD, an Indian pediatrician who grew up with a cleft lip and palate, wrote this section. She believes that explaining as much as possible about the deformity will help overcome some of the social and cultural problems experienced by children with a cleft lip or palate, who are sometimes confined to the home or shunned by others because of their appearance. Palreddy's section includes tips on overcoming difficulties with breathing, feeding or talking that the child may experience. This information will be translated, like the medical text, and will be given freely to family members. At this stage the CD is only available in English but plans are under way to create a version in Hindi. Other physicians have offered to translate the text into Spanish, Nepalese, Vietnamese and Greek, which will accommodate parents in many of the host countries Interplast teams visit.

The CD took six months to complete and was made on a "shoestring budget," according to Stephanides. Volunteers assisted with graphic design and content and they helped to gather and load the 800 images and six video clips that the disk contains. Stephanides is burning the CDs himself. The disk runs on Netscape Navigator and Internet Explorer versions 4 or higher. It can also be loaded onto a web server so doctors in remote locations can access it via modem. The CD was purposefully kept to a simple format to remain accessible to people without complicated software or powerful computers.

Interplast has already begun distributing the CDs and the feedback so far has been positive. It has already provoked interest from other groups, suggesting that North American surgeons desire an instructional CD of this sort. However, at this time it is only available via Interplast.

Development and production of the CD was supported by the Stanford-NASA Biocomputation Center, Stanford University Medical Media and Information Technologies (SUMMIT), The Smile Train, The Beaumont Foundation and Quixotic Design. SR