First TSF in Palestine 

Hgoug, is like any other 13-year old; loves playing football, flying kites and playing on the beaches along the Gaza Strip. Hgoug is from Khan Younis, a town in the southern part of the Gaza Strip with mainly an agrarian population. His father has olive trees and a field of vegetables which have been in the family generations. These fields are situated about 1km from the Israeli wall and no-mans land. On this day, 12th January 2009, Hgoug was with his father in his fields. All of a sudden, helicopter gun ships appeared on the horizon. The gun ships starting strafing the area with live ammunition. Hgoug was shot in the leg as he ran away, but the bullet did not slow him, in fact made him run and limp at great speed from the fields to the main road; his father trailing him, the bullets still whizzing and numbing passed them. A car drew closer to them and Hgoug was taken to Nasser Hospital in Khan Younis’s centre. By this time, Hgoug was in shock and the doctors transfused him and took him to operating theatre where his broken limb was splinted with an external fixator and the gunshot wound debrided and packed with clean dressings.

Treating Hgoug's Wounds

I met Hgoug in March 2009 as part of a visiting second Unit from MIST. Hgoug’s leg still had an open infected wound and the fixator was holding apart a shattered midshaft tibia. Hgoug himself was a fabulous patient. He was always smiling and looking forward to playing football again; by all accounts, he was a talented player. After long discussions with his parents, we took Hgoug to theatre with the plan to thoroughly debride the wound, to start IV antibiotics after cultures for 6 weeks and to apply a circular external fixator, the Taylor spatial frame (TSF). The TSF enables the Surgeons to correct any residual deformity in the leg. Moreover, the TSF gives enough stability for the patient to weight bear on his injured leg and this mechanical loading of the limb encourages healing of the bone. In addition, the TSF allows access to the shin wound for dressing.

Talking of Dreams

Six weeks after daily change of dressings, a posterior releasing incision was made in the calf and skin was approximated to close the wound on the anterior surface of the shin. Clinically and radiologically, the tibia showed signs of healing and 6 months after his first operation with MIST, Hgoug had his frame removed and his leg put in plaster for a further 6 weeks. On 12th December, I was in the middle of a busy clinic at Nasser Hospital, when through the crowd, a tall handsome young man stood there. He put out his hand and said in a deep clear voice, ‘Do u remember me Dr Sohail, I am Hgoug’. Both clinically and on Xrays Hgoug had healed remarkably well with minimal scarring or residual deformity in the leg. Hgoug was now playing for his local football team and had been recently picked for the South Gaza to play against the North! We went for a cup of tea and koonafa and talked of his dreams.

Posted on: 06 March 2015

Written by: Suheal (Sohail) Khan