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How a severely skull fractured patient from a road accident was saved through critical operations

doctor_amitabha-300x169 How a severely skull fractured patient from a road accident was saved through critical operations

On the day of Eid-ul-Fitr, when the whole country was celebrating, the family of Sahidul Islam Rudro was counting their heartbeats. The Eid-ul-Fitr, for the family started in a festive mood. However, the family hardly realized that an ordeal was waiting for them. The young lad of the family, Sahidul, who was full of life and energy, like any other boy took out his motorcycle and went for a ride. Then came the disaster. He collided with a four-wheeler and got severely injured. In a state of unconsciousness and the head was virtually split in the forehead, he was taken to a couple of hospitals, where it was said that they were unable to handle this kind of injury. He was referred to Apollo Hospitals Dhaka. He came to Emergency late in the evening of June 16, 2018 and got admitted under Dr. Amitabha Chanda, the senior consultant and head of neurosurgery. It was noticed that Rudro had severe open head injury and injury to the face surrounding the right eyeball. Brain matter was coming out of the wound. The forehead bone was shattered and the bone pieces were lost in the street. There was burst injury to the right eye socket and it was completely shattered. The patient was unconscious. A CT scan of brain and face was done. It showed shattered bone in skull with loss of bones. The brain matter was coming out. There was hemorrhage in the brain. There was burst injury of the right orbit with complete dislocation of the cheek bone. The eyeball was severely injured and looked unsalvageable. A consultation was sought from Dr. Tibar Banerjee, the plastic surgeon and Dr. Saidur Rahaman, the ophthalmologist. The challenges were manifold. The first challenge was to save the life of the patient. The second challenge was whether he would come out of consciousness, as he had severe injury to the brain. The third challenge was whether the infection to brain could be avoided, as the brain matter came out and the street dirt and mud went into his head. The fourth challenge was that there was severe injury to the right eye socket and right side of the face. Whether it would be possible to give shape of the face to the young lad. The first step was to save his life and prevent severe brain infection. He was operated in the early morning of June 17, 2018. In the first stage, the brain surgery was done. The herniated brain was repaired and the hemorrhage was treated. The covering of the brain was reconstructed with a tissue taken from his thigh. Whatever bone pieces were available were collected and were repositioned and were fixed with titanium miniplates and screws. Dr. Tibar Banerjee was also in the operating team. It was decided that although the right eyeball was badly injured, we should try to save it. We planned for reconstruction of skull, eye socket and face, if the patient survived and there was no brain infection. He was ventilated. Gradually he started improving in neurological response. After more than a week, he became conscious. He was repeatedly checked whether he was acquiring brain infections. Once he got stabilized, it was decided that repair of skull bone, eye socket bones and right side of face would be repaired. Accordingly he underwent second stage operation on July 3, 2018. Dr. Amitabha Chanda and Dr. Tibar Banerjee teamed up and did the operation. There was loss of bone in the skull. So it was not possible to attach and fix the bones of skull. There was loss of bone of the margin of the eye-socket bone. The defect was replaced by titanium mesh. The mesh was shaped like bone in forehead and eye socket margin and was fixed to give shape to the forehead and eye socket. Next, the cheek bone was repaired. At last the nasal bone was also repaired. The patient gradually recovered and started walking. He was discharged from hospital in good condition.

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