Ahad Israfil's courageous story has been reported by the national and international media. Most Daytonians know of his miraculous stuggle to return to a rewarding life in spite of the handicaps that might defeat many others. In a case of mistaken identity this young man was mortally wounded by a gunshot to the skull. After miraculously overcoming the odds, Ahad arrived at the emergency room of a nearby hospital. Dr. John Margolis, a neurosurgeon on staff at The Children's Medical Center, attended the young man.

My first encounter with Ahad occurred while he was being treated in Rehabilitation at Miami Valley Hospital in Dayton, Ohio. His physician's request for a consult because of Ahad's difficulties with wound healing and destroyed tissue brought us together for what was to be one of the most poignant personal journeys.

He was transferred to CMC where a free flap reconstruction using latissimus dorsi muscle was carried out on September 30, 1987. This reconstruction increased the blood supply to the defect so that healing could occur. However, the flap subsequently necrosed several weeks later. The flap provided some stable, deep coverage of the tissue and although it was ultimately lost, the tissue went on to heal primarily.

The major deformity of Ahad's skull was still present. The lost flap was never meant to solve this problem, and we still needed some extensive and innovative surgery to fill the big hole. I felt that reconstruction with a large, solid silicone block would be the best way to give Ahad firm, stable coverage that would also protect his remaining brain tissue.

Using computerized tomography techniques and three-dimensional computerized reconstruction, an implant was made by the Sinemax Company in California. Subsequently, the implant arrived in Dayton and was ready for implantation.

During the next operation I attempted to place the implant. The tissue was too tight and the implant would not fit. A tissue expander, similar to those used for breast reconstruction, was placed in the deformity. Once the tissue healed, we increased the size of the tissue expander using percutaneous injections of saline. This stretched the tissue slowly and gradually.

Ahad after reconstructive surgery.

The final operation on Ahad involved placing the implant. The tissue expander was removed, and the implant was then placed into the deformity. With the implant was in place, cranioplast was used to fill in the edges and correct the final, small irregularities on the surface between his skull and the implant. Ahad had good wound healing and his hair grew back normally. Since my successful treatment of Ahad, I have seen several other patients in the Dayton area with skull deformities who have required similar reconstructions.   Back to previous page