Instructions for Authors

Instructions for Authors

Introduction: Thank you for agreeing to write for The Manual! We intend to create an online, open access resource for surgeons practicing in resource-limited environments, such as low- or low-middle income countries. We hope to encourage and help practitioners who encounter complex disease and do not have access to specialists or reliable referral facilities. 

We intend for the Manual to be: 

  • Hosted on the Vanderbilt University Medical Center’s website. 
  • Completely open source, covered by a Creative Commons license.
  • Intended for physicians, surgeons in training, and practicing surgeons.
  • Low-bandwidth, easy to access even with poor internet.
  • Full of practical advice, illustrations that are easy to understand, and photographs that illustrate key points. 
  • Inspirational to other authors in austere environments; an example of what can be done with one’s own photographs and materials that are in the public domain. 

The Manual will be composed of the following Parts: 

  • Non-Technical Skills
  • General Skills
  • Specific Skills
  • Specific Problems (Further divided into Non-Trauma, Trauma and Pediatrics)

General instructions for authors: 

  • Write in a friendly tone, as though you were giving advice to a colleague. 
  • A knowledge of surgical basic science is assumed. Mention such concepts only as part of specific advice, relative to clinical practice. (Example: “Empiric antibiotic therapy for necrotizing fasciitis is directed at the following organisms:”)
  • Each chapter of the Manual will be available as PDF file to minimize bandwidth. 
  • No bibliography or references are necessary, but you are free to provide a list of “Further Reading” at the end of the chapter, including hyperlinks to other open-source materials. 
  • Anatomy drawings are to be taken from Gray’s Anatomy, as these images are in the Public Domain. One collection can be found at (The Editors can help you with these, or with making alterations such as lines and arrows on them.)
  • Radiologic photographs are to be taken from the author’s own collection, colleagues’ collections, or from, attributed as per instructions in that website. If you are not using your own photographs please provide attribution data (Example: “Photograph courtesy of Ronald Njoroge, MD”)
  • Photographs from Wikipedia, Wikimedia Commons or other public domain sites are acceptable, please attribute as instructed by the source website. 
  • If using photographs from a non-public domain site, it is the author’s responsibility to secure permission and attribute as instructed by the domain owner. 
  • Other illustrations that are not drawings from Gray’s Anatomy, photographs, or x-rays, should be discussed with the Editor.

Part 1: Non-Technical Skills: 

  • These essays are to be 3000-4000 words in length and should generally take a friendly tone, as a mentor giving advice to a younger surgeon.
  • A review of recent developments in these fields, such as the effect of communication or leadership style on outcome, is entirely appropriate. However, this review should strengthen the main thrust of the article, rather than being the whole article. 
  • Diagrams or tables are acceptable, but must be either original creations or used with permission and properly attributed. 

Part 2: General Skills: 

  • These essays are to be 3000-4000 words in length and should generally take a friendly tone, as an experienced leader would use when informally advising someone about to take over a new leadership position. 
  • Many of these issues are very difficult in austere settings, and have few agreed-on solutions. “Best practices” in our setting will be different from those in a high-resource location, or even from other low-resource settings. Where there is ambiguity, acknowledge that such is the case and explain the relevant issues as best as possible. (Example: Acquisition and Maintenance of Specialized Equipment.)

Part 3: Specific Skills: 

  • These are skills that are common to surgery. In some cases they are vital steps of the operations discussed in the “Specific Problems” section. (Example: Abdominal Incisions.) 
  • The mainstay of this section will be instructions and photographs, supplemented by anatomic diagrams in some instances. 
  • Make the photos as clean and clear as possible, with little background clutter. 

Part 4: Specific Problems: This is an explanation of the surgeon’s understanding, decision making, and specific steps of each operation. 

Each “Problem” will be its own Section. The first chapter introduces the issue, followed by a chapter for each associated Surgical Procedure. (Example: Enteral Access for Nutrition Section Introduction, followed by chapters on insertion of various enteral feeding tubes.)

  • Each Section will have its own Section Introduction followed by several specific Surgical Procedure chapters. 
  • Each Section Introduction chapter will be divided into four components: 
    • Background: A brief introduction to the disease as it affects this organ system. 
    • Anatomy: A discussion of anatomy here allows the Surgical Procedure chapters to be more lean. Use figures, photos, or radiological studies to support the concepts.
    • Principles: This section will reinforce and build on the anatomy, incorporating pathophysiology and the principles behind certain interventions. These principles lead into the next section.
    • Decision Making: This final section leads directly into each specific operation and helps the surgeon decide which to do, and when. 
    • Resource-Rich Settings: Where applicable, a text box bearing this title may be included, to describe other options for treatment outside of our setting. (See Box for more details.) 
  • Each Surgical Procedure chapter will be divided into three components: 
    • Introduction Build on and and re-state the information from the “Decision Making” section of the Section Chapter, as it applies to this specific operation. Finally, spell out the steps of the operation in broad terms, using bullet points. Keep these steps broad, the real “nuts and bolts” will be in the next step. 
    • Steps: Each step of the operation will be spelled out numerically. The first and second steps may include preoperative workup and any anesthesia considerations, if applicable. If there is an illustration, it will be displayed immediately after the step it describes. Please submit the illustrations separately with captions and figure numbers referenced in the text. 
    • Pitfalls: These are the potential complications, either intra-operative or postoperative. These should reinforce previous concepts that have been mentioned in the Section Introduction Chapter and the Introduction. Illustrations or photographs are acceptable here, but not necessary.