Over 25% of the global disease burden requires surgical therapy, which could save over 18 million lives per year. Yet, an estimated 2 billion people have effectively no access to surgical care, and 2 billion more have access only to surgeries performed in unsterile settings such as general-use buildings or even outdoors [1]. After disasters, field surgical areas are often exposed to particulate and insect contamination. In any case, intraoperative environmental contamination of surgical wounds results in high rates of severe, deep infections [2–4].

The need to provide safe surgical care in austere environments is well-known. Solutions have assumed that the problem is to have a sterile operating room outside of a standard facility. This paradigm underlies surgical tents, operating rooms on trucks, and semiportable laminar airflow systems [5–7]. These devices share significant limitations. They...

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