Medecins Sans Frontieres (MSF) surgeon David Nott provided a very public case report of successful forequarter amputation this week.

http://www.msf.org.uk/surgery_by_text_message_20081203.news

What made this extraordinary was that he and the patient were in Congo, he had never performed the procedure before and he received instructions on how to do it from a surgical colleague in the UK. The story has highlighted the challenging work that is undertaken by MSF. Mr Nott, a vascular surgeon, gives a month of his time each year helping provide surgical services for MSF.

Would this case report be published in BMJ Case Reports? In its detail it reminds surgeons of the complexities of forequarter amputation, but, that is quite a rare surgical procedure. It highlights how a highly trained individual can undertake a new task with minimal instruction and this encourages breadth of knowledge of anatomy and experience of techniques in surgical training. It also gives an insight into the social network of surgeons who, contrary to popular myth, are not isolated specialists but have strong friendships with colleagues and even send text messages.