Global Hospital successfully performs a high-risk surgery on a 1-year old Iraqi baby with a complex facial defect.

by Suman Gupta

~The baby was diagnosed with large vascular malformation over the left side of the face which resulted into swelling~

~Successful excision of Vascular malformations without causing significant scarring / cosmetic deformity of the face~

~A multidisciplinary approach by the hospital during this complex and high-risk surgery helped reduce the risk of blood loss / death~

~The availability of expertise and a timely intervention gave the baby a new lease of life~

Mumbai: A team led by Dr Nilesh Satbhai, Consultant Plastic and Reconstructive Microsurgeon successfully performed a complex reconstructive surgery on a year-old baby for a facial defect.  The child had a large and complex vascular malformation over the face. Vascular malformations lead to a swelling due to the excessive or abnormal development of blood vessels. This complex surgery was performed with precision without causing any facial deformities.

Baby Raimas Alzahayawat, was 1 month old, when her mother noticed swelling over the left side of her face. Soon, after which the family panicked, and ran from pillar to post, to find an appropriate solution. At 6 months of age, she underwent injection treatment (sclerotherapy) at a local hospital. However, there was not much relief. After this the skin over the swelling became fragile and the child had 2-3 episodes of severe bleeding from the lesion. According to the parents, the baby would continuously cry and refuse to eat food. With no treatment available locally, the baby was referred to Global Hospital, Parel, in July, wherein Dr Nilesh Satbhai, performed the complex surgery of removal (excision) of the vascular malformation and reconstruction of the large soft tissue defect over the face.

Dr Nilesh Satbhai, Consultant Plastic and Reconstructive Microsurgeon, said, “The child was worked up in a systematic manner. After thorough clinical assessment, we performed a CT scan with angiography and also a DSA (digital substraction angiography). This helped in detailed analysis of the vascular malformation and also the extent of the lesion. It was understood that there is a large vascular malformation over the left side of the face (involving the left cheek, angle of mouth, part of upper and lower lip, extending up to the nose and orbital margin). Vascular malformations are a complex problem formed by a developmental defect which causes the blood vessels in a particular body part to develop abnormally or excessively. This results in a mass or swelling which is full of multiple blood vessels. They can be of different types (hemangiomas, capillary malformations, arterio-venous malformations – slow/high flow), and vary in size from time to time because of swelling and blood flow within the malformation. They may present at birth or sometimes later. The rate of enlargement of the lesions is variable as per age of the child.”

He added, “Preoperative embolization was carried out to block the abnormal and enlarged blood vessels and reduce the blood flow to the lesion as this helps in reducing the risk of excessive blood loss during the surgery. Complete excision of vascular malformations is challenging but with the help of flap cover to reconstruct the large skin and soft tissue defect over the face, the lesion was successfully resected, with minimal blood loss (29^th June 2019). Thus, due to the multidisciplinary approach of the hospital, the complex surgery was performed on the small child without any major complications and a cosmetic outcome was achieved. The post-operative course was uneventful and the child was discharged after a week. She is doing well and all the wounds have healed now.”

Vascular malformations are dreaded conditions, and not many centres are well equipped to manage them, more so in such a small child. But, owing to the availability of expertise to handle paediatric cases, Global Hospital was successfully able to give the baby a second lease of life.

Montasir, patient mother said, “My daughter would continuously crying, and refuse to take feed or eat anything. We were unable to understand why she is doing so. We were shocked and alarmed when we noticed the abnormal swelling over the left side of her face which made it impossible for her to open the mouth. We were extremely afraid after the episodes of severe bleeding from the lesion. We were not able to find any suitable doctors or hospitals in Iraq to deal with this problem. Global Hospital gave us a new ray of hope. We thank the hospital for the prompt treatment, commendable approach and successfully treating the baby. My child is now cured of the problem and is looking normal now. We are especially happy with the cosmetic result, in spite of such a major surgery. She has started accepting feeds and is more playful now.”