When 7-year-old Salman Fairouz of Kuwait City, Kuwait, heard his 5 a.m. alarm for school, he didn’t want to get up. Having stayed up late, he decided to sleep a tad more. When the alarm went off at 5:30 a.m., he got ready quickly.
On that March day in 2017, Salman and his brother Hussein, 6, both heavy-eyed, walked outside to catch their bus at 6 a.m. Both nodded off on their way to school.
The boys were jerked awake when the speeding bus rounded a corner, became unbalanced and toppled on its side. The windows shattered; glass was flying. Salman had fallen asleep with his hand on the bus window; he could feel it dragging on the pavement as the bus skidded to a stop. Hussein’s arm was lodged under the bus.
The bus driver and a bystander freed Hussein and the boys retreated to the side of the road. “Salman’s jacket sleeve was red with blood,” recalls Hussein. “I was scared for him.”
Their mother, Dalal Ahmad Fairouz, looked at her phone around 7 a.m. and saw missed calls from the boys’ school and some random numbers.
“I knew something was wrong. I called the school and was told there was an accident and the boys were in the hospital,” recalls Mrs. Fairouz. She and her husband, Mohammad, immediately drove to the hospital.
“I was told Hussein was ok, but Salman had a severe arm injury. The main artery and median nerve were cut,” remembers Mr. Fairouz. He thought his son’s hand was gone.
Salman was taken to surgery to repair the extensive injuries to his left arm. Unfortunately, the wound closure was not successful and he underwent two more surgeries to cover the major artery, nerve and bone of his arm. After three failed surgeries in Kuwait, doctors there couldn’t do anything else to help Salman; he risked amputation of his entire arm.
“The first priority was to go abroad and continue treatment. I wasn’t in good shape to travel because I was pregnant and had to take care of Hussein who also required surgery,” says Mrs. Fairouz.
A week after the accident, Mr. Fairouz emailed Cleveland Clinic seeking help. “Salman had a large open wound with a major blood vessel and nerve exposed. I saw the pictures and I felt we could help save his arm. The surgery was an emergency,” says Bahar Bassiri Gharb, MD, PhD, a plastic surgeon at Cleveland Clinic Children’s.
The email was sent on a Tuesday and that Saturday, Salman and his father, accompanied by a physician and nurse, arrived at Cleveland Clinic Children’s – a 7,000-mile journey. Salman was in very critical condition and in a lot of pain. “The flight was most dangerous because the artery could rupture,” says Antonio Rampazzo, MD, PhD, another plastic surgeon at Cleveland Clinic Children’s.
“The amount of damage to the area around the arm was extensive,” says David Gurd, MD, orthopaedic surgeon at Cleveland Clinic Children’s.
The next few days were spent planning the surgery and making sure that Salman was in optimal physical condition. This was a major procedure, like an organ transplant, where tissue was removed from Salman's thigh and transferred to the arm using microsurgical techniques.
They used world class technology, world class knowledge to make sure Salman had the best results. I’m grateful for that.
During surgery, Dr. Bassiri prepared the blood vessels for the tissue transfer, took a nerve from the leg and repaired the large defect in the median nerve. At the same time, Dr. Rampazzo took the tissue from the thigh with the vessels that were carefully prepared to allow the tissue to survive. Dr. Gurd attached an external fixation device – used to stabilize the arm and prevent motion to allow the arm to heal.
Once the bone was fixed, Drs. Bassiri and Rampazzo — using the operating microscope — repaired the vessels to restore the blood supply to the soft tissue harvested from Salman's thigh. “In one surgery, we were able to take care of everything,” says Dr. Rampazzo. “It was amazing, considering the severity of the injuries and the infection in the tissues.”
About 10 days later, Salman was discharged to Cleveland Clinic Children’s Hospital for Rehabilitation to undergo intense physical therapy to regain motion in his fingers, hand and arm.
Because Salman and his father were from Kuwait and would be in Cleveland for an extended amount of time, they were connected with Cleveland Clinic Global Patient Services (GPS) – a department dedicated to serving the needs of international patients.
“Our patients make us even more passionate about providing medical care and non-medical care. We feel this is our way of contributing to the global community,” says Nizar Zein, MD, Chairman, Global Patient Services. “For international patients, their medical journey starts and ends with GPS.”
GPS was instrumental in getting Salman to Cleveland Clinic Children’s so quickly. “Things were very unstable with his infection and exposed artery. He most likely would have lost his arm had he not arrived so soon,” recalls Dr. Bassiri.
Four months after the successful surgery to treat his injuries and save his arm, Salman’s family reunited in Cleveland. “They used world class technology, world class knowledge to make sure Salman had the best results," says Mrs. Fairouz. "I’m grateful for that.”
Salman has regained full function of his arm and hand. He is on his way to getting back to playing his favorite sport, soccer, and would like to be a heart surgeon when he’s older. “It’s Cleveland Clinic that actually saved my hand. Without them I’d have a prosthetic hand now. They’re the ones who helped me,” says Salman.
Dermatology & Plastic Surgery Institute,
Orthopaedic & Rheumatologic Institute