Emory surgical team saves a hand, saves a life
By Jennifer Browning
At 13, Amos spends his summer vacation working to help support his family. At sunrise, he goes down to the river, collects the sand on the bottom, places it in large buckets and then carries it to a central location.
Over a week ago, Amos fell and punctured his hand while at work. Not wanting to worry his family, he told no one about his injury. Within a week, Ann, his mother, began to notice Amos wasn’t sleeping.
That’s when Amos showed her his hand, which was swollen and showed signs of infection. Ann brought her son to the government hospital in Hinche last week where doctors prescribed antibiotics and tried to clean the wound. They recommended that Amos return to see the doctors arriving from Emory.
When the doctors from Emory met Amos, his hand was enormously swollen and he was complaining not only of pain in his right hand, but all the way up to his shoulder. His forearm was already showing signs of swelling. The surgeons determined that Amos was suffering from necrotizing fasciitis.
“He is the bread winner in his family, he fell and probably had wood penetrate the wound, those are dirty wounds in general, and they are set up for rapid bacterial overgrowth,” Dr. Jahnavi Srinivasan, a visiting surgeon from Emory said. “So when he got here he was actually septic, he had a very high fever, he couldn’t move his fingers at all. If this had gone on too long there wouldn’t have been a chance of his hand coming back.”
The infection was so bad that there was a possibility Amos could lose his hand or had the infection worsened, his life.
The surgical team comprised of Dr. Srinivasan and Dr. Viraj Master decided to perform surgery to relieve pressure from the wound.
“He had global body wide infection and non-use of his hand,” Dr. Master said.
Ann said she is thankful for what the doctors could do here.
“The Lord has given me grace to help my son. I prayed for something to come, and the Lord sent me these doctors to help my son,” she said. “I am very happy. After thanking God, I thank the doctors for coming here. The doctors are very nice and professional.”
Three days after the surgery, the surgical team says that Amos’s wound is overall healing well, but there are still concerns for the young boy.
“The concern is that it is going to form a bunch of scar tissue, and as the scar tissue forms, the skin is not going to be as elastic as regular skin,” Ira Leeds, a third-year Emory medical student said.
Leeds explained that this elasticity problem would prevent Amos from being able to open and close his hand properly. In order for him to regain full use of the hand, he will require a skin graft and long-term physical therapy.
Dr. Srinivasan and Dr. Master plan to do a skin graft on his hand today, because they are not sure when he will have the opportunity to see a plastic surgeon. And if the wound care isn’t done properly, the hand could become infected again.
“He would have died if we hadn’t debrided this and if it gets infected again he could die,” Dr. Srinivasan said. “Normally when you have a wound like this you wait seven to 10 days just to make sure the superficial bacterial counts from the fresh tissue has gone down because it gives you a better chance of the skin graft taking and healing.”
The surgeons are hoping the skin graft will take. Project Medishare’s nurse liaison, Maguy Rochelin, is staying in touch with the patient so if Amos needs another skin graft she can possibly schedule Amos to see the next plastic surgery team arriving to work at Bernard Mevs/Project Medishare hospital in Port-au-Prince.