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 members of Sahidul Islam Rudro were counting their heartbeats. Like everyone else they started the Eid on 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 crashed headfirst into a four-wheeler from the opposite side and got severely injured. In a state of unconsciousness, his head being virtually split in the forehead, he was taken to a couple of hospitals, where they were told that the hospitals 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 a 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 the brain and face was done. It showed shattered bones in the skull with some pieces missing. The brain matter was coming out. There was a haemorrhage in the brain. There was burst injury of the right orbit with complete dislocation of the cheekbone. The eyeball was severely injured and looked un-salvageable. A consultation was sought from Dr Tibar Banerjee, a 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 can be brought back to consciousness, as he had severe injuries to the brain. The third challenge was whether the infection in the 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 a severe injury to the right eye socket and right side of the face and whether it would be possible to retain the shape of his face.
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 haemorrhage was treated. The covering of the brain was reconstructed with a tissue taken from his thigh. Whatever bone pieces were available were collected and repositioned and were fixed with titanium mini-plates and screws. Dr Tibar Banerjee was also in the operating team. It was decided that although the right eyeball was badly injured, there should be an attempt to try to save it.
The doctors planned for reconstruction of the skull, eye socket and face. Luckily, the 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 the skull bones, eye socket bones and right side of the 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 damaged bones in the skull. There was loss of bone at the margin of the eye-socket. 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.