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Thinking outside the square (Joan Chapple)

Excerpt from: http://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=10517894
Author: Sarah Lang, for NZ Herald.
Originally published Monday Jun 23, 2008

Next door to Masson in a dark, decidedly-more-rudimentary house, Dr Joan Chapple sits, scanning the newspaper. Chapple's initial claim to consequence is as New Zealand's first hand surgeon and first female plastic surgeon. But at 78, with deep creases around her eyes, she couldn't be much more removed from the botoxed nip and tuck mercenaries.

Rather than sidestepping into highly-paid, highly-respected private cosmetic surgery, she held the fort at Auckland's hospital stable (Middlemore, Greenlane, North Shore and Auckland) between 1958 and 1994, latterly as a freelance plastic surgery specialist and teacher. "As the only woman, I never felt welcome in the surgical profession."

In 1972, unmarried, she gave birth to a daughter. While she wanted only five months off from Middlemore, her job wasn't kept for her. And career-long, it was understood she wouldn't attend professional-surgeon meetings at the men-only Northern Club. She didn't want to push the issue. "I was already fairly offside with my superiors, because I wouldn't go by the status quo if I thought there was a better way."

Gradually, Chapple developed and practised an unorthodox thesis about mending wounds without stitches. As a senior staffer, despite management frowns, Chapple was left to practise and teach her way. And her treatment of hundreds of patients, extensive case notes and photographs, books, teaching and speaking engagements, the adoption of the technique by doctors and nurses countrywide, and specialist referrals to her, suggest she was on to something.

In standard woundcare, stitches, tapes and tight bandaging restrict blood circulation, and circulation is key to healing. Says Chapple: "Stitch it up and make it look good sounds lovely, but my approach works with the body's agenda to heal itself, not against it."

Her technique is to first immobilise and anaesthetise, then inspect and clean the wound, as is standard. Then her treatment differs: one applies tape-like tulle strips (a soft mesh-cotton), gauze then a crepe bandage in a figure-of-eight fashion, only using a stitch if absolutely necessary. By not absolutely closing the wound, this technique allows any further bleeding to come through the mesh into the dry-gauze layer rather than accumulate within, while reducing swelling and pain, and leaving less scarring.

Trained medical staff can apply the technique to anything from a large wound to a clean cut. Chapple's not saying standard treatment doesn't work; she's saying each wound's circulation needs to be carefully assessed first.

While sometimes doctors can get away with standard technique, she says they often can't when it's a poor-circulatory area such as the leg, or when there are dangerous or multiple injuries. Most doctors treat the throbbing pain, rather than releasing the tension causing the pain. Circulatory complications can lead to infections, gangrene, and more procedures. Many have seen the technique's merit.

Chapple has presented papers at GP conferences, travelled countrywide teaching doctors and nurses, lectured to surgical trainees, and handled many difficult-wound referrals. But her technique has never been accepted as standard. "My superiors were stuck in traditional modes and wrote me off as an eccentric, too passionate." She was expected to conduct a trial with cases treated both ways.

"But by the time you know one way's better it's completely unethical to be treating some people another way." So she wrote her own reference book. With no joy from publishers she self-published in 1980, and in 2001 updated and expanded it into Wound Care and Healing: the Physiological Challenge, based on further experience, case studies and a unique set of clinical photographs.

In 2001 Chapple received a New Zealand Order of Merit for services to medicine and the community. While she's quietly proud of the honour, what she'd really like is for her technique to be accepted "for the difference it would make to patients, not for personal glory."

"You don't set out to be outside the square. You just do what you think's right and you find yourself there, surprised."

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