Surgeon saves severed thumb of machete victim

The Bradford shopkeeper who had his whole thumb sliced off by a machete has had it successfully re-attached by a top consultant plastic surgeon.

Tasawar Iqbal suffered the appalling injury as he defended himself against five raiders at his Wibsey convenience store last Wednesday night.

He raised his right hand to shield himself from a machete – which cut straight through the v-shaped gap between his thumb and forefinger and down through his wrist bones, totally removing the whole digit.

He was rushed to Bradford Royal Infirmary where consultant plastic surgeon Ajay Mahajan went straight from a seven hour emergency operation on a child and started work on Mr Iqbal at 4am on Thursday.

“The machete blow had severed his entire thumb having entered what we call the first web space between the thumb and first finger,” Mr Mahajan said.

“He had caught the full force of the blade which then went down to the wrist, inside the heel and taking the thumb completely.

“Re-attaching a thumb is more complex than putting a finger back on as it does so much more than the other digits. It does much more flexing and rotation and uses bigger muscles to do so,” said Mr Mahajan, who heads the hospital’s famous Plastic Surgery and Burns Research Unit.

“The first thing was to put the bones back together to create a structure to build on,” he said.

“Then I joined up the arteries, veins, tendons, nerves, ligaments and muscles.”

Mr Mahajan said the sharpness of the machete’s blade had actually made it an easier task than if the thumb had been ripped off in an accident. It was easier because the tissue and everything had been neatly cut. But the main thing was that the thumb had been properly preserved.

Amazingly, by Friday Mr Iqbal had already regained some movement.

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LABIAPLASTY – WHY WOMEN GET IT DONE!

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It’s an issue that is often kept secret, locked behind closed doors in the confines of a woman’s most intimate world. Noticeable to only a chosen and trusted few, this private insecurity is a very real problem for those who have it, which can explain why many women are opting to undergo this particular procedure—all in the hope that they can feel confident enough to let their guard down.

Labiaplasty is a surgery that seeks to correct hyperplasia of the labia minora, said Dr. Arie Benchetrit, a plastic surgeon at the Cosmedica clinic in Montreal. Hyperplasia is an overgrowth of the small lips – the rough, pinkish or pinkish-brownish lips that extend from the opening of the vagina. The operation is done in order to shrink the small lips and to put them in better proportion to the large lips (the labia majora), which is the skin where pubic hair is located. A woman can be born with an overly large labia, or it can stretch over time, and as a result of childbirth, mentioned Dr. Benchetrit.

“Normally, in an ideal situation the small lips should just barely stick out beyond the large lips and with patients who seek a labiaplasty, they often stick out several centimetres beyond,” clarified Dr. Benchetrit.

In rare cases, an overly large labia can result in infections, especially fungal infections, but this is not a frequent complaint, Dr. Benchetrit elaborated. The main reason women seek this procedure is because of esthetic concerns.

“They’re embarrassed by the appearance of what they consider to be overly large small lips. I’ve had patients come in, they won’t even have sexual relations, because they don’t want to be intimate and have the man see this and think less of them,” mentioned Dr. Benchetrit. “They think it’s a significant cosmetic issue. Some of them [also] have functional issues, such as pain. Especially when they are riding a bicycle or [during] any other activity where there is friction in the area.”

Dr. Carlos Cordoba, a plastic surgeon at the Plastic and Esthetic Surgery Clinic in Montreal, agreed. “Sometimes sitting or certain clothing may be uncomfortable due to the pinching of the excess labia minora.”

Dr. Benchetrit and Dr. Cordoba noted that there are two different approaches for conducting labiaplasty, which are both done under a local anaesthetic. The first approach is known as a “trim” technique, where a surgeon would put local anaesthesia in the small lip of the vagina and then just cut across, getting rid of the excess skin.

The second way to conduct the surgery is through a “wedge” technique. Here, the doctor would remove a wedge of tissue within the lip and then suture the two ends together. After the wedge has been removed, the doctor would then only cut the lining of the lip (mucosa) and leave the deep tissue where all the nerves are (the submucosa) intact. The advantage of this technique, Dr. Benchetrit expanded, is “one, you preserve sensation, because you’re not cutting nerves and two, you’re getting a much more natural looking labia minora afterwards, because you’ve preserved that irregular edge.”

“The goal of labiaplasty surgery is to minimize the amount of labia minora protruding or extending beyond the labia majora with minimal scars,” Dr. Cordoba added.

Patients can go home right after the procedure, where they should put ice on the operated area constantly, and only get up when absolutely necessary.

“After 48 hours, they can gradually resume going for walks; and those who have sedentary jobs, where they can sit at a desk all day, will usually return to work after three or four days. They can start light exercise after two weeks; and at six weeks it’s fully healed and they can resume any type of exercise, as well as sexual relations,” added Dr. Benchetrit.

Dr. Cordoba explained that in the 24 to 72 hours after the surgery, there will be some spotting, similar to when you are menstruating, along with discomfort when sitting and walking.

Risks of the surgery include bleeding, infection, overcorrection, reoperation and asymmetry. Dr. Benchetrit noted that asymmetry is not much of a risk though, “because the lips are usually asymmetric to start with, and the asymmetry (if that exists) afterwards is very minimal.”

He emphasized though that it is essential for patients to take it easy in the days following the operation. “We use long-lasting dissolving sutures, but if there’s too much activity in the first few days, she can sometimes rupture a suture, which could cause bleeding.”

The doctors disclosed that patients are happy with the results post-procedure and the overall “neater” and more proportional appearance of their labias. Feeling good about herself, a patient can also get a significant self-confidence boost.

Dr. Cordoba’s patient, 48-year-old Sara*, would agree. After Sara turned 45, she started to notice changes that she wasn’t pleased with – her labia hung lower than it used to and the hue became darker.

“You’re aging and it’s a very slow process. But at some point you say, ‘Wow! Something’s happening here!’ It’s basically to make it look tidier,” explained the mother of three.

Other than feeling a little bit sore for the first day or so, Sara noted that the surgery was virtually painless and that the recovery was “very easy.”

Sara added that she was very happy with the results and that she was glad that she got the procedure done.

“It’s basically a facelift,” she said with a laugh. “It looks younger.”

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