New hope for the children reached with  Xeroderma Pigmentosum

A team of Egyptian doctors under the direction of Dr. AYMEN ABDELWAHEB (Ass. In surgery in the National center of Cancerology), made a success of a graft of skin of face of a small girl reached of " Xeroderma Pigmentosum ". 

The old techniques consist in making a graft of the skin of the same child whereas all the skin is reached of this congenital disease. 

After great progress of microsurgery and the first graft of the face in France in 2005, the idea came to Dr. ABDELWAHEB to replace the skin of the face of the patient by a healthy skin of a donor. 

Child HOUDA 5 years old had a sister died by the same disease at the 14 years age. 

First   stage:  To convince the mother by explaining all the stages and the risks to him of the intervention, this mom who saw her first daughter dying out in front of her eyes was not long in collaborating with the team of the surgeons in end to avoid a second suffering.  The examinations of compatibility found a compatibility with 90% with her brother and to 50% with his mother but for reasons the etiques ones one chose the mother like donneuse.   These tests were made by the team of Dr. Ghada MOSLEM (Clinical Biology), Dr. Hana QRAQSI (Pediatrist) and Teacher Âla HADDAD (Carcino-Pediatry and graft of marrow), they decided in end the nature and the amounts of the immuno suppressor. 

The most difficult moments started with the beginning of the intervention, according to Dr. ABDELAWAHEB, the mother and her daughter was installed each one in an operational room.  A first team consisted Pr BASYOUNI Mahmoud (Pr and service head of surgery) and Dr. SAMER SAMIR removed the skin of the face of small.  The second team of Dr. ABDELWAHEB, Dr. KARIM SALLEM (Ass in Surgery), Dr. YOSRI MAJED, Dr. MOHAMED CHAKER and Dr. GHALI JALEL took the graft of the arm of the mother while keeping his vascular and nervous network.  This graft was washed in continuation by heparin at end to eliminate all the blood cells and immunizing from its circulation, while knowing that small girl HOUDA was put under immuno suppressor since the day before. 

After having to release the blood vessels and nervous fibres of HOUDA one began the graft itself with micro surgery to anastomose the arteries, the veins and the nerves.  One spent six hours for the realization of this intervention which is the first in its kind in the world. 

THE OTHER HEMIFACE?? 

For the remainder of the face one will use the technique " Exenpender " by putting a small baloon of physiological salt solution under the zone grafted to increase his surface then to extend it on the remainder of the face.  But all that will take a little more time to carry it out. 

WILL THE SMALL HOUDA TAKE THE IMMUNOSUPRESSOR FOR A LONG TIME? 

In the first time we made a success of the surgical operation, now remains to follow small the day after day by fear of refusal of graft which remains the great concern... one will decide according to the evolution. 

WHY YOU DO NOT HAVE TO SPEAK ABOUT THIS INTERVENTION BEFORE SA REALIZATION? 

Unfortunately, there was many obstacles to surmount because of some which do not cease putting we beat them in the wheels, for nonscientific reasons. 

Will know that one spent one year for finally carrying out this exploit, certain doctors was retissant because of the responsibility médicolégale. 

IF EVER THE SURGICAL CONTINUATIONS ARE NOT SATISFACTORY? WHAT SAY YOURSELF? 

Our goal is to relieve the small HOUDA and thereafter all the children reached by this disease.  It is necessary to take many risks to arrive there. 

WHY YOU DO NOT HAVE USE HER SKIN FOR THE GRAFT? 

It is what one did front but it is not effective because all its skin is reached by this disease and will not be able to resist the sun.  For that one had recourse to a healthy donor which is the mother for our case

THE SMALL BENEFICERA OF A SURGERY ESTHETIQUE THEREAFTER?

Certainly and it is my difficult by far that the first intervention. 

IF YOU WOULD MAKE A SECOND INTERVENTION LIKE THIS ONE?  WHAT WILL YOU AVOID OR WHAT YOU WILL MAKE MOREOVER? 

I will increase the surface of the graft bus at the beginning one was afraid and one tended to decrease surface to be grafted by fear of the risks. 

Our comments  (Dr Zghal Mohamed)