| Danial Norjidi |
THE prompt response and decisive action by the medical team at the Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital as well as the quick thinking of a father not only saved a girl’s life, but also enabled her to keep her arm after sustaining severe injuries in a car accident.
Nur Nawal Husna binti Mohd Khirul Effendi, two years and four months old, sustained injuries to her right upper-arm and left leg in the accident. The injuries were so severe her arm was almost completely severed, according to a member of the medical team that carried out her treatment and surgeries.
The incident happened around 3pm on January 31, said Mohd Khirul Effendi bin Haji Yussof, the girl’s father, in an interview with the Bulletin.
“We were on the road, heading from Jerudong towards Kampong Rimba,” he recounted. “Our car was hit by another from behind and it turned over to the front.
“After it happened, everything was a blur. I looked for my wife and children.”
A father’s prompt response in the face of horror and the quick response and decisive action by a medical team saved a young child severely injured in a car accident. – PHOTOS: MINISTRY OF HEALTH
He found his nine-year-old daughter fine and had moved away from the car to the side of the road, while his wife, Haslinah binti Haji Omar had suffered a leg injury. His youngest daughter, Nawal, was seriously injured in the arm.
Upon seeing his youngest daughter’s condition, Mohd Khirul said he was first taken aback, but then took action. As a soldier, he is trained in basic first aid. He took his wife’s head scarf and used it as a tourniquet, tying it around his daughter’s wound and applying pressure to it to lessen the bleeding.
Mohd Khirul said the ambulance arrived 10-15 minutes later.
Dr Rohayati Taib, Consultant Paediatrician, commended the father’s prompt response. “What he did was really sensible. He made a tourniquet which prevented further bleeding and also covered the wound.”
There were no internal or head injuries, but Dr Sasidharan P R, Specialist Plastic Surgeon at RIPAS Hospital, described how severe Nawal’s injuries were.
“The right upper arm was almost completely cut off from the body – it was just hanging loose by a single piece of skin. A part of the bone in the middle was lost, all the muscles were badly damaged, and the major blood vessels and nerves were all cut,” he said.
“She also had an injury to her lower left leg, with the ankle bone exposed.”
Dr Rohayati and Dr Sasidharan both highlighted that Consultant Plastic and Resconstructive Surgeon Dr Chan Koo Guan took a very strong leadership role in the surgery and care for Nawal, and showed great dedication to the cause.
A number of significant procedures were carried out for Nawal’s treatment, some of which are the first of their kind to have been done on a child in Brunei, including a replantation of the arm.
On admission, a debridement was carried out to clean and remove damaged tissue. This was followed by bone fixation and the replantation of the amputated right upper limb, which took about seven hours and was done by plastic surgeons and orthopedicians. Next was the re-exploration for a blocked vein, which took three hours.
For Nawal’s leg injury, a debridement and a free gracilis muscle flap operation were done to cover the exposed right ankle, which took six hours. Further debridement and skin grafting were done for the replanted forearm, along with external fixator application, taking around three hours. Last of all, dressing changes were done, under anaesthesia.
Nawal’s condition in the hospital was constantly monitored by the medical team, whose vigilance and care allowed for a swift recovery
The procedures were very intricate and required great precision. For the replantation, Dr Sasidharan explained, the blood vessels and nerves, muscles and tendons were reconnected under a microscope, which is very rarely done on small children because the vessels are very small, and with children, it is very difficult.
“She underwent four or five surgeries before we could gain some normalcy to the hand. The whole time she was under the care of paediatricians for life-saving measures.”
Dr Rohayati said that they made sure that not many people visited the child and exercised very strict infection control. “Management of her care was very much a team effort,” she said, noting that Nawal was monitored 24 hours a day.
Dr Sasidharan said that Nawal needed constant monitoring and the monitoring by the team had been excellent. It was highlighted that every member of the team at the hospital showed “good teamwork from the very beginning… Everything was fast, and (the team) gave the right treatment at the right time and looked after the patient well.”
In one instance, the doctor shared, “a venous congestion was noted immediately and within half an hour she was taken to the operating theatre.”
Dr Sasidharan said that this was significant “because if it is detected a little late, (the situation will be) beyond repair, nothing can be done and you’d have to amputate the hand.”
Dr Rohayati said that the first three days were “touch and go”, but Nawal is “a fighter”.
Nawal has since returned home and has begun her recovery and rehabilitation, having been officially discharged from hospital two weeks ago. Dr Sasidharan said that there is no more risk of infection, and that Nawal’s hand can now be trained to function.
Her father said that she has been making progress, and has started returning her normal self again. He said she no longer seems to be traumatised, and is happy being in her home environment and playing with her siblings and cousins.
“She’s becoming happy again,” he said.
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