Our First Free-Tissue Transfer Surgery Gives 10-Year-old Salih a New Lease Of Life

Salih Idris Salih able to run for the first time, following his free-tissue transfer surgery eight months ago.

In March 2022, Swisscross performed the first ever free-tissue transfer surgery at the Centre of Excellence for Complex Care, Erbil on 10-year-old Salih Idris Salih who suffered debilitating injuries to the leg from a missile attack in 2017. 

The devastating injury left Salih, who was five at the time, with missile fragments and a gaping hole in his lower right leg, with bone exposed and lack of muscle. The injury never healed, and he suffered recurrent infections, and pain, leaving him unable to walk properly.

Living in a refugee camp in Erbil with his family, Salih was referred to Swisscross by local NGO Barzani Charity Foundation earlier this year. Our team of surgeons quickly realized they could not simply put the bones back together with plates and screws in his leg, because the damage to Salih’s tissue and muscle was too extensive and in its current state any hard-wear would break down and come out through the skin surface. 

The only feasible surgery for this young boy who had lived with his acquired disability for the last five years was a free tissue transfer or free flap surgery. Essentially the "transplantation" of healthy tissue from one site of the body to another, in order to reconstruct the existing defect.

Dr Natasha Forster, performs the first free-tissue transfer surgery at the Centre of Excellence for Complex Care in Erbil.

Dr. Natasha Forster, a microvascular specialist from Zurich, Switzerland working with a team of surgeons -  Swisscross Chief Surgeon Dr. Walter Kunzi, and leading local plastic surgeons in Erbil - Dr. Alla Shukur, and Dr. Mustafa Subhe  - performed the complicated procedure of transferring healthy muscle from Salih’s back to his lower leg. The team painstakingly reattached and reconnected arteries and veins in both surgical areas - the back and leg – ensuring the flow of blood to the muscle from the newly connected vessels was successful.

The surgery took six hours, after which doctors were pleased to see the blood flow between the connected vessels was moving effectively, allowing Salih to recover fully.

After eight months of recovery and physio, Salih is able to run and play like any healthy young boy. The surgery has truly been life-changing for Salih and we believe can help hundreds of other children with similar injuries.

Dr Natasha Forster providing free-flap surgical training with local plastic surgeon, Dr Sarmad Nashat, using a chicken leg.

In our commitment to train and mentor local surgeons, Swisccross led a free-flap training session in Erbil this month. Many major hospitals perform the procedure, which is a highly practiced skill. The failure rate of the surgery can be high if done with little experience. At Swisscross we are committed to knowledge sharing with our counterparts in Erbil and exposing them to the technique, so more children like Salih can receive the treatment they need much earlier following disability-acquired injuries.

The importance of complex surgery in conflict settings where people have been injured by weapons is a critical need, which offers long-term solutions. It offers the opportunity to reverse and or reduce physical trauma, so patients can be more mobile and live healthier lives.

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