Doctors discuss Joud's surgery

Dr Amir Ibrahim from the American University of Beirut Medical Center (AUBMC) led the surgery on Joud this week. He was joined by two specialists from America to support the surgery - Dr Edward Chang and Dr Roman Skoracki. All in all, the operation took over 10 hours. We sat down with them and asked them to go through the operation, and the implications this will have on Joud’s life.

Can you give us a quick summary of the operation that was performed on Joud?

Joud INARA Arwa Damon Syrian Refugee

Dr Ibrahim: When the blast occurred, Joud lost the all the bones in the middle of his face. This caused his face to collapse. The only way we could fix this problem was to replace these bones with other bones in his body, in order to re-project his mid-face. This will allow him to, in the future, put some dental implants in.

The best bone to use is one that comes from the leg. It’s a narrow and long bone. We cut it into pieces and then we put in some plates and screws to hold it into place to reproduce the missing bone.

With that bone we also needed to take some skin to resurface the roof of his mouth, which will also cover a hole inside the roof of his mouth.

Was this one of the longest surgeries that you’ve performed?

Dr Ibrahim: These types of surgeries are some of the most complex that you can do in plastic surgery. You’re transplanting tissues from other areas of the body and putting them somewhere else.

Generally speaking, these operations take a very long time. Only a few specialised centres in the world do operations like this.

Dr Chang: The blood vessels that we sew together are only a couple of milometers big so we have to sew them together with a microscope. There’s a risk that blood could stop flowing and all the work that we’ve done so far could be for nothing. It’s only a one in ten chance but it becomes a nightmare – you lose all the work you’ve done and have to do it all over again.

It’s not a very frequent operation in the United States, and there are very few centres in North America or Europe that can do it.

INARA Joud's mother Arwa Damon Syria

What impact will this have on Joud’s life?

Dr Ibrahim: It’s the functioning aspect. Before the surgery he could not chew properly. He had a hole in his palate so every time he ate or drank some food or water could go up to his nose. This surgery will improve his speech, his swallowing, and the way he chews. That’s in addition to the cosmetic outcome and the impact this will have on his self-confidence.

Why do you feel a need to work and help people like Joud?

Dr Ibrahim: At AUBMC we have lots of unfortunate patients – and lots of them cannot afford any type of treatment, not even a clinic visit. So we’ve been getting lots of patients that have been taken care of by INARA – like little kids burnt. The work we do will have a major impact on their lives

My last patient from INARA was a patient whose elbow was locked and she couldn’t use it. When she next saw me she came to me with a hug and tried to hold my hand. It’s a big thing that INARA is doing. There are other associations in Lebanon, I have to give them credit, but I think INARA is the only one bringing smiles to faces to people who are really traumatised by conflict. I hope you continue to do the work that you do – for the sake of many, many, many future patients.

Dr Chang: I’m just happy to be a part of this. Myself and [other surgeon] were so happy to have had this opportunity to come, help out. Because there is a big need for these types of operations to help people who do not have the means to help themselves.

How did you find out about this case? How did you end up flying to Lebanon from USA to do this?

Dr Ibrahim: We had this Lebanese Society meeting. Joud’s case was scheduled in during this period, and I was talking to Roman [Skoracki - another surgeon from the USA who worked on Joud’s surgery] and Ed and I told them about it. Ed is known for these types of reconstructions, and they said: “if you want help, we can help.”

Working together we could speed the operation up so Joud wouldn’t have to be under anaesthetic for as long.

AUBMC was very welcoming to the idea of helping Joud. I really want to thank them because they really did help us.