Our comittment to Dorah is to see her through her operations, hopefully most
concluded within her childhood. Other people who have had severe burns or
similar deformities to those that Dorah has, have had operations spread over
many many years, because some aspects cannot be rushed and because the body and
the mind need to rest and build between operations.
If Dorah is forever in hospital she has little chance of catching up on
schooling, normal development and social interaction / family life. Most people
who are injured during childhood or born with deformities, continue to have
operations well into their adult life.
Here are some of our informed guesses on Dorah's timescale. The surgeons
involved do not like to commit themselves far ahead because they are terribly
aware of the potential for many a slip twixt cup and lip.
Age five - 1999 - corneal graft and cataract removal on right eye;
improving shape of lips. Maybe starting another tube pedicle; maybe trying to
move other tissue into place. MAYBE all the surgery fails and has to be tried
again the following year.
Age six - 2000 - right upper and lower eyelid muscle work. Maybe
moving more skin into forehead area to allow bone replacement technique in the
future under better quality skin (this would not work now as there is not
enough stretch in the skin that is there). There are bone replacement methods
that now grow with the recipient.
Age seven - 2001 - maybe still needing to move tissue in the face or
into the face (as Dorah's body gets bigger, she is more able to spare skin).
One can elect to make a saline or air bag "pregnancy" under certain
areas of skin to stretch them - but the UK surgeons seem not as keen on this
method as their South African counterparts. The problem with delaying moving
skin is that while Dorah's skull is now growing in a better shape than before,
it is still not growing in the correct proportions and evey year skin / tissue
movement is delayed, her head will grow more deformed and much of that may be
irreversible. It is compensating for areas of tightness (all around the nose
region, the forehead, the stretched deformed ears) by growing too much in other
areas. The lip work in 1998 has allowed Dorah's jaw to start to move towards
its proper alignment but she is still a long way off being able to close her
Age eight - 2002 - more work on hands. Prosthetic thumb implants.
Opening left stump (though in fact this is likely to be tackled much earlier).
Keratodontoprosthetic corneal graft to left eye using part of Margaret's
jawbone and /or eye teeth to give Dorah's left eye a chance to see.
(Christopher Liu pioneered this surgery in the UK.) Maybe if all is settled in
well - then only eyelid muscle operations between age eight and ten.
Age 11 - 2005 - skin grafts into the chest area before Dorah starts
to develop breasts. The skin there is too tight and following recent
discussions with burns doctors in Cape Town it has become apparent to me that
Dorah will suffer great unnecessary pain if her chest scarring is not improved
Age 12 onwards - improvements to previous work; extra tissue movement
to allow for growing body size. If all the trustees had time or inclination to
read the considerable amount of text on the burns survivors websites (at least
one is cross referenced to from our own site), it would be clear to them that
the operations will have to continue for a long time but can decrease in
frequency over the next couple of decades. The sort of aspects that are of
great emotional importance to people with damaged faces are to be able to smile
when they want to. And to be able to have the normal facial features like
eyebrows. Dorah has no eyebrows. One adult male who fell into a fire when he
was camping, lost his eyebrows. He was operated on to move hair into the
eyebrow region, because this feature was important to him. What he hadn't
realised was that his new eyebrows were of a different sort of hair that grows
rapidly like the hair on one's scalp and so he will have to cut his eyebrows
every single day for the rest of his life. Dorah does not have a normal
hairline, so her face appears too big. Both eyebrows and hairline can be dealt