Mumbai doctor saves forearm, hand of a Nepal-born month-old girl from amputation

Image for representational purposes only. Photo Courtesy: iStock

A newborn girl child was brought to Wadia Hospital three weeks after birth. The child was born in Nepal. Her mother had a bad obstetric history. Out of the six pregnancies in the past, the mother had lost four children.

The baby had been in an ICU in Nepal, where she was diagnosed with severe cellulitis which resulted in necrosis of the skin on her entire left forearm. The majority of the skin on her left forearm had turned black and this resulted in deterioration of the child's condition. The father shifted the child to a bigger hospital in Kathmandu. However, they were recommended amputation of the left upper limb. The parents were not willing for the same and they decided to come to Bai Jerbai Wadia Hospital For Children in Mumbai for further treatment.

Bai Jerbai Wadia Hospital for Children successfully performed a complex multiple-staged surgery to save the forearm of her two-month-old girl child, thus preventing any amputation. The timely surgical intervention, intensive care support, and efficient wound care ensured that the child remained stable. This critical surgery was performed by Dr Nilesh Satbhai, consultant plastic, hand, and reconstructive microsurgeon, and his team.

Satbhai, said, "On arrival, the child was admitted to the pediatric intensive care unit (PICU) for resuscitation. The intense medical management resulted in the stabilisation of the child's condition in the next few days. The exact cause of the skin necrosis was not known as the history was unclear."

Cellulitis is a bacterial infection that occurs in the skin layers and often manifests as painful, hot, red swelling on the body. The main culprits behind cellulitis are Staphylococcus and Streptococcus bacteria.

Treatment involves antibiotics and is usually effective. However, in some cases, cellulitis can deteriorate rapidly if left untreated or unresponsive to antibiotics. This escalation could result in a critical medical situation and potentially a life-threatening outcome.

In the child's case, the cellulitis led to flesh-eating disease, necrotising fasciitis, which is an infection in the deepest layer of skin spreading to the connective tissue that surrounds your muscles and organs. This may result in gangrene (tissue death). In more severe and irreversible cases amputation might be inevitable.

Dr Satbhai added, "We saw the child immediately after admission and decided to salvage the limb by quick action. As soon as the medical condition was permissible, we planned to clean up the wounds, remove all the dead tissues, and reduce the source of infection. We planned for wound cover and reconstruction in multiple stages. After the first stage of wound debridement, multiple wound washes were performed. The wound was then covered with a large abdominal flap which covered the majority of the wound over the forearm. The child was just a month old at this time. The anaesthesia management for this major surgery was extremely challenging and critical."

"The flap was maintained in position for three weeks. The flap division was performed in two stages. The final flap in setting was done after ensuring that the entire wound was covered on both sides of the forearm. All these surgeries were done in five weeks. The child is stable and achieving normal developmental milestones. Her hand is salvaged due to timely surgical intervention and wound cover. Secondary reconstructive procedures will be needed for further function as the child grows up. Not treating her at the right time could have led to amputation and lifelong disability."

"The intricate surgery required to salvage the limb of this small baby at Wadia Hospital showcases the exceptional expertise and advanced technology. We are elated to have saved this baby from lifelong disability and help her regain her hand function," said Dr Minnie Bodhanwala, CEO of Wadia Hospital.

"With the steady hands and unwavering determination of the team led by Dr Satbhai, our baby's delicate forearm was spared from the looming threat of amputation. It was a harrowing experience, watching our little one face such a daunting challenge at such a tender age. We had lost all our hopes when we were advised of amputation even at the biggest hospital in Kathmandu. Dr Satbhai's expertise and quick thinking were nothing short of miraculous, as he skillfully navigated through the complexities of the situation with precision and care. We are extremely happy to have come here. We are planning to name our child Tamannah," concluded the patient's father Abdul Awwal.