Pune doctors operate on 6-year-old girl to restore paralysed limb

Pune hospital doctors along with the 6-year-old girl. Pic/ Chaitraly Deshmukh

A 6-year-old Yemeni girl child who suffered paralysis on her right hand was operated in a Pune hospital by a team of specialist doctors to restore the paralysed limb. The Yemeni national patient Aya Mohammed (6) had met with a road traffic accident six months ago. Unresponsive, she was brought to the emergency department of a hospital in Aden, where she remained for three months in an unconscious state.
As she slowly regained consciousness, her parents noticed that she had weakness and reduced muscle power in her right upper limb. It did not improve over time and she was unable to lift her arm up and bend her elbow.
Desperate to find a cure for her condition, her parents reached out to the Paediatric Hand Surgery department at Jehangir Hospital in Pune. The specialist doctors in Pune, diagnosed her and found out that she has a traumatic brachial plexus injury which was responsible for the paralysis of her upper limb.

Speaking to Mid-Day Dr. Abhijeet L Wahegaonkar, Adjunct Professor of Hand Surgery at Jehangir Hospital said, "The brachial plexus is a complex network of nerves that originate near the neck and shoulder. These nerves begin at the spinal cord in the neck and control the hand, wrist, elbow, and shoulder. Brachial plexus injuries most commonly occur after an accident, sports injury or during childbirth, and can leave the arm without function."

Aya's nerves got cut during the accident, causing the paralysis on her right upper limb. Although Brachial Plexus birth palsy is more frequently seen in infants and children, traumatic brachial plexus injury is extremely rare in children, with an incidence of less than 0.1%, said the doctor.

"In my 20 years of practice, this is the first such case I have seen! Usually such injuries are seen at birth, during forceps delivery or a traumatic injury at birth. Even in road traffic accidents such an injury is usually seen in adults. Should the limb not recover in 4-6 months, surgery is the only recourse of treatment in such a case," explained Dr. Wahegaonkar.
The surgery at Jehangir Hospital on August 24, was performed by an inter-disciplinary team of Paediatric Hand and Microvascular Reconstructive surgeons, paediatricians, neurologists, anaesthetists and physiotherapists. The procedure went on for seven hours.

Dr Wahegaonkar explained that the surgery was a challenging one, he said, "as the nerves in children are particularly small and delicate. It's also an extremely risky area with several vital structures in the vicinity. Also, surgeries and treatment are time bound. We spent a week in preparation of the surgery and now the post-operative care will continue for another next 6 months. The surgery was a microscopic procedure and was extremely specialised. What made the surgery possible was the availability of the infrastructure and teamwork required for these specialty surgeries. It makes it possible to carry out the complex procedures and after care."
Even though Aya reached the doctors at Jehangir Hospital late (the ideal time frame is within 3 to 6 months), the doctors are positive about the outcome. "In such surgeries, the success rates are 90-95% and as she is a child, we hope the body will help it heal faster. Hopefully, she will be able to lead a normal life." he added.

The family is counting all their blessings. Says Ebrahim, (Aya's relative) post Aya's discharge, "No words in any language can help me express my gratitude towards the doctors of the Hospital."

The Pediatric Hand and Brachial Plexus and Peripheral Nerve Injury centre at Jehangir Hospital is a cooperative, interdisciplinary centre for evaluation and management of traumatic and brachial plexus birth palsy and peripheral nerve injuries, an educational resource for the public and healthcare professionals, and a research centre.

The surgeons are extensively trained and perform delicate surgeries regularly using advanced microsurgical techniques (including nerve and muscle transfers) to repair the damaged brachial plexus nerves. The Hand surgery team led by Dr. Abhijeet Wahegaonkar included Dr. Satish Mane, Dr. Anup Bansode and Dr. Chaitanya Karande-Patil.

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