Mumbai: Bai Jerbai Wadia Hospital for Children successfully performed a complex multiple-staged surgery to save the forearm of a two-month-old girl child from Nepal, thus preventing it from amputation. The child had developed severe cellulitis of the left forearm at the time of her birth. She developed a severe infection immediately after birth, resulting in gangrene (necrosis) of the entire skin over the forearm. The skin over the entire forearm had turned black and the parents were advised amputation of the limb. The timely surgical intervention, intensive care support, and efficient wound care ensured that the child remained stable and her hand was salvaged. This critical surgery was performed by Dr Nilesh Satbhai, Consultant Plastic, Hand, and Reconstructive Microsurgeon, and his team.

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 6 pregnancies in the past, the mother had lost 4 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.

Dr Nilesh Satbhai, Consultant Plastic, Hand, and Reconstructive Microsurgeon at Bai Jerbai Wadia Hospital for Children said, “On arrival, the child was admitted to the pediatric intensive care unit (PICU) for resuscitation. The intense medical management resulted in the stabilization 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 a flesh-eating disease, necrotizing 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 1 month old at this time. The anesthesia management for this major surgery was extremely challenging and critical.

The flap was maintained in position for 3 weeks. The flap division was performed in 2 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 5 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. The team worked tirelessly to meticulously plan and execute the procedure, with a focus on precision and innovation. By harnessing cutting-edge techniques and state-of-the-art equipment, they can push boundaries and offer hope in what once seemed like an impossible situation. 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 as our little one faced such a daunting challenge at such a tender age. We had lost all our hopes when we were advised for 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. Our journey with Wadia Hospital has been one filled with hope, resilience, and ultimately gratitude for the unwavering commitment to saving our baby’s forearm from amputation. We are extremely happy to have come here. We are planning to name our child ‘Tamannah’,” concluded the patient’s father Mr. Abdul Awwal.