Dr Mohan let it mature with blood supply on the forearm before transplanting it on her face assisted with micro-vascular surgery. The result seems right out of a sci-fi book where a patient with a stub of a nose now has a real nose on her face apart from the many other aspects on her face that were worked on to give her face a near semblance of normality.
Giving an acid attack victim a fighting chance at life
The story of Hosni, 38 as she he flew back to her country, in the last week of January 2021 — smart, restored and confident-, is that of grit, courage, tenacity, ingenuity and above all, the triumph of human spirit.
I fell and my face was on fire
It was only a few weeks after that break-up, recalled Hosni, narrating her story to Gulf News. “The day, the date and time when my life changed so horribly is etched in my mind — May 29, 2008, 9.30am. I was hurrying to the salon, walking on the road when this man who I had broken off with, suddenly accosted me on the street and threw what seemed like a bottle of water on my face. I fell down and felt my face was on fire. The pain was so intense that everything felt numb after that. Someone called an ambulance. I felt my face had frozen and my hair had all burnt up, I was in complete shock.
I suffered horrible pains
At this hospital, Hosni spent six months as doctors derided her dead skin, cleaned out her melted eyelids and nose and upper lip and just tried to keep her infection low with strong doses of antibiotics. As the young woman went from hospital to hospital, her dreams of love and marriage evaporated in the aftermath of the brutality as she endured painful surgeries for cleaning, debridement and skin transplants from her own body to cover the deep burns on her face.
Jibes and humiliations
There were many and eventually, a few of them reached out to her and told her about Dubai’s Prosthetic Sculptor Ashwaq Hassan Al Hashmi of Omniyati Prosthetic Arts Centre and Hosni reached out to Al Hashmi to pick up the pieces of her life.
Victims of acid attacks
A glimmer of hope at last
Without losing time, Dr Mohan and his team began working. In a series of fat grafts carried out from the patient’s body, the healing process was initiated. The team began with processed fat grafts containing her own stem cells from elsewhere in the body to heal the face scars, inject volume and given the facial parts a healing skin cover.
Dr Mohan worked to reconstruct the upper and lower eyelids so that the artificial eye could look natural; next he reconstructed the upper lip. Dr Mohan recalled, “Heba then did something she was afraid to do for many years, she washed her face and overcame her fear that her facial skin would come apart with the wash. When I watched the video of her performing this simple act with great trepidation initially and then with a whoop of joy, it was a moment that both Ashwaq and myself will never forget,” he recalled.
Growing a nose for Hiba
However, this is where the brave victim, who was willing to endure pain to get a real nose, put her foot down. “Hiba was adamant that she would not hear of a false nose that came off like her prosthetic eye at night. She told me that since I had been able to restore her cheeks and other features, I had to think of someway for giving her a permanent nose. The skin on her face and arms had burnt off and I had no idea how I would do it. But her faith in me, set me thinking. After much thought and some reading, I had a eureka,” recalled Dr Mohan. “First, a tissue expander was placed underneath the skin of her forearm to create more volume moment when the plan crystallised in my mind.”
In the next surgery, the expanded skin was lifted up and shaped it like a nose with help of wires. Cartilage and bone from her rib was used to provide create the internal skeleton of the nose. Dr Shahram Sajjadi, plastic surgeon at the AACSH, was a key collaborator in this surgery. Once that was done, the nose- shaped natural structure was allowed to rest and mature and heal on the forearm where it looked like the forearm had sprouted a nose. It even had the design of nostrils and columella incorporated into it, recalls the doctor.
A microvascular transplant miracle
Dr Mohan added, “All the facial vessels of the patient had got burnt. The challenge was to connect the microvascular system of the transplanted nose on the face and connect it to the vascular system to get a blood supply. We used the veins and arteries from the neck to create this connection. The adjacent cheek skin was integrated in a flap surgery to create the inner lining skin of the nose over which this structure was sutured. Once the blood supply through the microvascular system was connected, the nose simply became part of Hiba’ face.
Chiselling the nose in its final shape
In two recent procedures carried out during the pandemic period, the nose was chiselled into a refined shape, using Piezo technology of tissue sculpting. Dr. Mohan acknowledged the help and inputs by Dr. Sajjadi at this stage again.
The young woman now had a smile, a nose and despite the scars, the results were nothing less than a miracle. The patient’s hair grew back and in places where the roots were charred, Carole el Khaoule, a make-up artist who specialises in semi-permanent make-up and magic tattoo, worked on the scalp to create a semblance of volume. As a gesture of showing solidarity with the victim, el Khaoule rendered her services, free of charge. She also created eyebrows and lip definition for Hosni.
Hope for help to restore some eyesight and heal more scars
She had a message for other victims. “Never lose hope, or the will to live. Fight to be heard, keep your belief in God intact and have faith that there are such wonderful people in the world like the team of doctors and my anonymous benefactor, who have changed my life. I know I need more surgeries to make my nose better, my left eye can only perceive light and I am hopeful that some other benefactor will come forward to help me regain some vision. However, for now my only wish is to walk on the road with my face towards the sky and feel the breeze on my face.”
First aid for acid burns
* Wash the whole affected area with copious amounts of plain water to dilute the acie and wash it away. This is even more important than calling the doctor or rushing the victim to hospital and needs to be done immediately.
* All clothing must be removed after the initial wash;
* Make the victim stand under a shower to wash off all residues for 5 minutes.
* If the face is affected, wash the eyes with running saline solution, one can prepare saline solution in a few seconds by dissolving a teaspoon of salt in 1 litre of water. plain water irritates the eye and the victim may shut her eyes.
* Make sure to open the eyelids gently and the saline must be used continuously for a minute at least to wash off the acid.
* After this apply Vaseline or clean vegetable oil can be applied to burn areas and the victim taken to a hospital emergency.
Heba’s journey timeline
2. Improve tightness in the whole face by fat graft
2. Further improve tightness and bring soft tissue
3. Reconstruct right lateral nasal wall
2. More fat graft to face
3. Insert expander balloon in right forearm to make more skin for fabrication of nose
Eighth 16.11.2020 [delay due to Pandemic]
2. Hairline was brought forward
5. Fat grafting to the whole face again
6. Full thickness skin grafts placed in preparation for eyebrow tattooing
2. Augmentation of upper lip left side
4. Injection of SVF cell mixture for softening of all scars and to bring regenerative cells to her face.
1. Eyebrow tattoo by microblading on grafted skin
4. Tattoo for the hairline with missing hairs
5. Hair styling and colouring
6. Eyeglasses to complement her face
Heba Hosni, a young Egyptian woman who was a victim of an acid attack, poses her treatment with Dr Mohan Rangaswamy, chief plastic surgeon (right) and Dr Shahram Sajjadi, plastic surgeon. Photo: Virendra Saklani/Gulf News
Original news source Credit: gulfnews.com