Facial Regeneration: The Inside Story of a Breakthrough in Plastic Surgery

How Advanced Plastic Surgery Saved The Life of a Grieving Mother.

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Dr. Srinjoy Saha performed a breathtaking surgical innovation in the middle of the covid-19 pandemic, saving an accident survivor from myriad complications. “Minimalistic reconstruction surprised us with an impressive result as compared to traditional flap surgery and microsurgery,” he said. “I performed this case when the lock down and the pandemic had curtailed our regular hospital services. Even with constrained medical resources, this revolutionary procedure ensured high reliability and patient safety. It is a fascinating example of achieving more with less.”

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An accident survivor.

A frail, aging lady in her mid-fifties got admitted into the intensive care unit with critical injuries over her brain, skull base, cervical spine, dorsal spine, lungs, and ribs. Earlier, she had survived a terrible road traffic accident by the skin of her teeth, even as her teenage daughter died on the spot.

 

The patient became inconsolable when she first learned about her daughter’s death. It wrecked her mentally and sapped out her willingness to live any longer. In the wards, she would relate the dead black forehead area with her dead daughter and weep hysterically. Combined with her innate fear of extensive surgery and her anxiety of lifelong disability or death from spinal fractures, her anguish was becoming difficult to manage.

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A terrible problem.

After her medical condition had stabilized, another problem cropped up. As a result of the initial impact of the injury, skin and soft tissues over a large area of her forehead did not survive. A large black area containing gangrenous tissues developed over her upper face. After excising out these dead tissues, an extensive area of bare skull bones formed over her forehead and scalp, comprising a major area of her face.

 

A large forehead defect, sized about the palm of the hand, is a serious challenge to any plastic surgeon. During the reconstruction, a surgeon needs to maintain all the anatomical landmarks intact. Eyebrow and hairline cannot be deformed at any time. Otherwise, it would lead to a lifelong facial deformity.

 

When the usual fall short.

Usually, plastic surgeons treat these types of body defects with flap surgery. Surgeons can match the color, texture, and contour of a forehead defect with only a well-designed adjacent forehead flap. To preserve the hairline and the eyebrow, they can thus borrow merely a small amount of surrounding tissues when performing such a flap surgery. 

 

But, the treating doctors feared that an extensive flap surgery performed under general anesthesia would devastate her already fragile health. In fact, any movement of her neck either during surgery or anesthesia may turn out to be fatal. With her existing skull base fracture and cervical spine fractures, the fear of lifelong disability or even death was real.

 

Known alternatives fail as well.

As an alternative, a collagen-based dermal regeneration template, which was available locally, would not survive when applied directly over bare bones. So, even this alternative was not an acceptable option. The chances of success with any procedure turned out to be extremely slim indeed!

 

A desperate family.

Meanwhile, the patient’s husband fervently pleaded to all the doctors to save his wife. Teary-eyed, he kept repeating that he had already lost his daughter and would not survive if he loses his wife as well. With a much younger son back at home, his desperation was becoming evident from his recent mood swings.

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Test of fire makes fine steel.

Confronted with a herculean challenge, Dr. Srinjoy Saha responded by performing a tissue-engineered reconstruction under local anesthesia. First, he trephined the exposed skull bones, hoping to regenerate cells migrating from the underlying marrow. Next, he placed a tissue scaffold comprising a bi-layered absorbable polyurethane over the extensive wound. Last, he injected activated platelet-rich plasma all around the wound to enable tissue growth inside the scaffold.

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The results were nothing less than spectacular!

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Soft tissues regenerated throughout the scaffold, covering the enormous area of exposed skull bones. The original wound size shortened considerably. Skin graft placed over the remaining raw area stuck well. The ultimate results were fascinating and well-appreciated.

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Lower costs were a relief.

The patient’s family finances were stretched thin by the initial bills of neurosurgery and intensive care treatment. In comparison, the plastic surgery bills were minuscule. The patient’s husband said, “We returned to perform the second surgery on a Monday. Dr. Srinjoy Saha did the surgery under local anesthesia the very same day, and on Tuesday we were on our way home. The hassles and costs of hospitalization were remarkably less.”

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Benefits of minimalism.

Minimalistic reconstruction reduced her fear and anxiety in 2 different ways.

First, the procedure involved short, simple surgeries without making any cuts anywhere else in the body. The pain and discomfort during and after the surgery were minimal. Second, the procedure could be performed under local anesthesia and light sedation. The rigid neck collar and halo brace were not removed anytime during her treatment. This assured her that there will be no detriment to her spinal fractures and that she will not be endangered by this procedure.

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A grateful patient.

Asked to comment about the results, the patient said, “The results of the surgery were stunning, to say the least. Given the extent of the injury, I have recovered amazingly well. We all are very satisfied with the results of the operation. It has improved my quality of life and helped me get out of the depression and fearfulness that followed the car crash and death of my daughter”.

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Within months after her procedure, the patient and everyone else noticed tremendous physical and mental improvements. Even as she gradually overcame her grief, the reconstructed area appeared almost identical to the surrounding forehead.

 

Massive improvements.

Psychologists and therapists in charge of her treatment opined that a good cosmetic appearance played a key role in improving her mental state. Dr. Srinjoy Saha and his team diligently recorded the severity of evoking unpleasant sensations by the affected forehead area both before and after the surgery. Charted on a visual analog scale, the observers noted a massive improvement in her mental condition after the minimalistic reconstruction procedure.

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The Patient's final impressions.

When asked to make her final comments about this new treatment, the patient said, “This was the best miracle we had ever received in years. I came to the hospital in a coma and nearly dead. There was a real chance of suffering a life-long disability or even death if I underwent usual plastic surgery. But this new minimalistic technique was awesome! I left the hospital with a new life and a real sense of hope. I cannot thank Dr. Srinjoy Saha enough for being such a great doctor and my savior.”

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Tissue Engineering - The Future of Reconstruction.

 

Tissue engineering is a whole new field of creating new human tissues by combining cells, a biodegradable tissue scaffold, and activated growth factors derived from the patient's body. Science advances by leaps and bounds every passing year. So does technology for reconstructing human function. Worldwide, the fields of tissue engineering, cell therapy, and regenerative medicine are flourishing rapidly.

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Several studies are showing innovative ways of increasing cell growth and tissue regeneration. These innovations provide workable alternatives to many plastic surgeries in current practice. All these studies aim to restore tissues under practical and optimal conditions while minimizing scars and functional impairment.

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Credits: The grieving accident survivor's story was transcribed and written for this article by Jyotirmoyee Chakraborty.

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