Mumbai hospital saves Nepal infant girl's gangrenous arm from amputation

Mumbai, March 21 (IANS) A prominent Mumbai hospital saved the arm and hand of a two-month-old girl from Nepal who was born with medical complications after birth leading to gangrene, from amputation, officials said here on Thursday.

Soon after birth, the child developed severe cellulitis on the left arm which led to infection and resulted in gangrene (necrosis) on the entire arm, alarming the parents.

The skin of the entire forearm had turned black, leading to deterioration of the child’s health, and doctors at a major hospital in Kathmandu advised amputation of the limb to save her life.

Unwilling to amputate their tiny girl’s arm, barely three weeks after her birth, they rushed her from Nepal to Mumbai’s Bai Jerbai Wadia Hospital for Children (BJWHC) and immediately examined by Consultant Surgeon, Dr. Nilesh Satbhai.

“We decided to salvage the limb and as soon as her medical condition permitted, we cleaned up the wounds, removed all the dead tissues and reduced the source of infection. Then we planned for wound cover and reconstruction in multiple surgical stages,” said Dr. Satbhai.

After the first stage of the wound debridement, it was washed multiple times and then covered with a large abdominal flap which almost fully covered the arm, by the time the child turned one month old.

The flap was kept for another three weeks and underwent a two-stage process that ensured the entire wound was covered on both sides of the child’s arm.

All these complex and multiple surgeries were performed in a span of five weeks, though the anaesthesia management for the major surgery on the infant was extremely challenging and critical, he added.

After all the procedures were completed, the child’s arm was saved from a potential amputation, and she became stable and started achieving normal developmental milestones.

“Her hand was salvaged due to timely surgical intervention and wound cover. Secondary reconstructive procedures will be needed for further functions as the child grows up. Not treating her at the right time could have led to amputation and lifelong disability,” said Dr Satbhai. Later, the medicos learnt that the child’s mother had a bad obstetric history and out of six previous pregnancies, she had lost four children, but the exact cause of her infant’s skin necrosis is not known yet.

Cellulitis is a bacterial infection that occurs in the skin layers, often manifests as painful, hot, red swelling on the body.

The main culprits behind cellulitis are Staphylococcus and Streptococcus bacteria, but antibiotics are usually effective, though 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 when medical expertise and advanced technology were deployed for the Nepal baby, said BJWHC CEO, Dr. Minnie Bodhanwala.

In this 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, that could result in gangrene (tissue death), and in more extreme cases, require amputation.

The distraught parents, including father Abdul Awwal, are now smiling and happy and full of gratitude to the BJWHC authorities for saving the arm of their child whom they have decided to name ‘Tamannah’.



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