Download pdf file - IPRAS

able to provide personal hygiene care for herself, a rightthat should be basic to any adult human being.The Operating Theatre on the EFHAbout the PatientsFor five consecutive days, from April 24th to April 28th,our team performed approximately 61 procedures in 32patients. Many of these patients had multiple sites of burninjuries. The ages of the patients ranged from 2 to 70,and the most commonly performed procedure was burncontracture release and reconstruction using a full thicknessskin graft. Since the intent of the WFW is not to be anexclusionary program embedded in feministic ideology, wealso performed upper extremity burn contracture releasesfor two little boys who presented to EFH.Case 1:Accidental Soot Burns to the PerineumThe most complex and demanding procedure of thismission involved the release of a severe full thicknesssoot burn to the perineum of a 17 year-old girl. Shehad an extensive burn contracture of the perineum thatresulted in webbing of the proximal 1/3 of her inner thighskin. (Figure 4a) Preoperatively, she had approximately25 degrees of abduction between her proximal legs.Functionally, due to the distal extent of the webbingin her groin and both inner thighs, she was unable toprovide independent perineal care. As a result, she wasrendered to an infantile status where she had to haveher basic personal hygiene needs provided by her familymembers. After reviewing her surgical options whichwere limited due to the presence of full thickness burnsto both her thighs and the difficult nature of healingin the perineal region, we decided to reconstruct theanticipated large perineum defect caused by release ofthe contracture using a pedicled right vertical rectusabdominus myocutaneous flap (VRAM). (Figure 4b)Since the EFH ORs are not equipped with ventilatorswhich excluded the option of providing generalanesthesia and paralysis to the patient, we wererelegated to performing the entire surgery underregional anesthesia and conscious sedation. (Figure4c) In addition, to maximize the safety of the surgeryand minimize OR duration, the three surgeons workedin concert and completed the entire surgery within anacceptable time frame with minimal blood loss. Thepatient was ambulating with assistance by postoperativeday 1 and tolerating solid foods by postoperative day 3.Most importantly, for the first time in 3 years, she wasCase 2:Dowry Dispute - Burns to the Face and NeckA 22-year-old girl was attacked by her mother-in-lawand sister-in-law the day after her wedding, by settingfire to her veiled face and sari, as a result of an unsettleddowry dispute. As a result, she sustained third degreeburns to her face, neck, chest and arms. After barelysurviving the initial extensive burns, she was finallyrepatriated by her own family for the remainder ofher recovery. Feeling ashamed and worthless with herphysical scars, her family had taken her to the EFHto seek our reconstructive expertise. (Figure 5a,b)She underwent release of severe burn contractures tothe right side of neck with local flaps and FTSG, earreconstruction using a superiorly based pedicled tubedflap, and release of flexion contracture of her indexfinger. (Figure 6a,b) Despite our reconstructive effortsat restoring some semblance of normalcy to her faceand hand, she will likely remain a woman who will bepermanently physically and emotionally scarred by thistragic and preventable assault.The FutureIn a society built on thousands of traditional ritualsand customs, intentional burn attacks on women isone ritualistic practice that must be eliminated. Eventoday, one Bangladeshi woman is attacked with acidevery two days. Especially in the “char” regions ofNorthern Bangladesh, where its residents have beencompletely neglected by the government and foreignnon-government organizations (NGO), WFW intendsto strengthen its loco-regional presence in assistingmarginalized female patients who have nowhere elseto turn. With the support of local organizations suchas Friendship, and continued funding from EmiratesAirlines and other sponsors, WFW team aims establishsustainability by educating, preventing, treating, and reintegratingfemale victims of burn injuries.Toni Zhong, MD, FRCSC, MHSPlastic and Reconstructive Surgeon,Surgical Oncologist, Staff SurgeonAssistant Professor, Division of Plastic& Reconstructive Surgery,Dept. of Surgery, University of TorontoEDITOR’S NOTE:We would like to report on a typographic error in theprevious edition (5th) of the IPRAS Journal “Women ForWomen” article entitled “2nd Mission - The Chilmari,Bangladesh”. It was incorrectly attributed to the Presidentof the Women For Women effort when the author was Dr.Toni Zhong. We are reprinting the article under the nameof its appropriate author with our sincere apologies.24 IPRAS Journal www.ipras.org Issue 6