The child had developed a severe infection immediately after birth, resulting in gangrene of the skin on the forearm, which had purportedly turned black all over. But a timely, life-saving surgery saved her hand.

Imagine the plight of the parents of a two-month-old baby, when they faced the difficult prospect of watching their child lose a hand, owing to a severe infection that had become a great threat to her health. The baby from Nepal reportedly developed ‘severe cellulitis’ and infection immediately after birth, resulting in gangrene (necrosis) of the entire skin over the left forearm. A complex ‘multiple-staged surgery’ was done on her to save the forearm and prevent amputation. For the unversed, cellulitis is a bacterial skin infection that causes redness, swelling, and pain in the infected area. If left untreated, it can spread and cause health problems. In order to prevent it, one must ensure good wound care and hygiene. In this patient’s case, she was treated at the Bai Jerbai Wadia Hospital for Children in Mumbai.

The Case

As mentioned earlier, the child had developed a severe infection immediately after birth, resulting in gangrene of the skin on the forearm, which had purportedly turned black all over. Her parents were advised to amputate the infected limb. But a timely, life-saving surgery saved her hand. The surgery was performed by Dr Nilesh Satbhai, consultant, plastic, hand, and reconstructive microsurgeon, and his team. The baby was brought to the hospital within three weeks of her birth. Her mother reportedly had a poor obstetric history, having lost 4 children out of the 6 pregnancies that she had.

The baby was previously in an ICU in Nepal, where she was diagnosed with severe cellulitis.

While her father shifted her to a bigger hospital in Kathmandu, the doctors still recommended amputation of the left upper limb. Disheartened, the parents decided against it, and thought of travelling to India for treatment. That is how they arrived at Bai Jerbai Wadia Hospital.

The Treatment

Dr Satbhai said that on arrival the infant was admitted to the pediatric intensive care unit (PICU) for resuscitation. “The intense medical management resulted in the stabilisation of the child’s condition in the next few days. The exact cause of the skin necrosis, however, was not known as the history was unclear.”

The doctors first decided to clean the wounds, remove all dead tissues, and reduce the source of infection in order to save the hand. “We planned wound cover and reconstruction in multiple stages. After the first stage of wound debridement, multiple wound washes were performed. The wound was then covered with a large abdominal flap, which covered the majority of the forearm. The child was just a month old at this time. The anesthesia management for this major surgery was extremely challenging,” Dr Satbhai added.

• The flap was maintained in position for three weeks.
• The flap division was performed in two stages. The final flap in setting was done after ensuring the entire wound was covered on both sides of the forearm.
• All the surgeries were done in five weeks.
• The child was stable, but ‘secondary reconstructive procedures’ will be needed for further function as she grows up.

About Cellulitis

The doctor explained that the main culprits behind cellulitis are staphylococcus and streptococcus bacteria. Its treatment involves antibiotics and is usually effective. In some cases, cellulitis can deteriorate rapidly if left untreated, or if the patient is unresponsive to antibiotics.

“This escalation could result in a critical medical situation with a life-threatening outcome. In the child’s case, the cellulitis led to a flesh-eating disease ‘necrotizing fasciitis’, which is an infection in the deepest layer of skin spreading to the connective tissue that surrounds the muscles and organs. This may result in gangrene (tissue death). In more severe and irreversible cases, amputation might be inevitable,” he concluded.