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My Proximie

Dr Nadine Hachach-Haram, Founder and CEO of Proximie, and frontline NHS surgeon, discusses the mythical power of the operating room.

Growing up in post-war Lebanon in the early 1990s shaped my desire to become a surgeon.

Seeing the human impact conflict exacted on my homeland had a profound influence. You would see a lot of deformities, people with arms and legs injured and missing. Things that perhaps you shouldn’t see as a teenager. I look back at devastating events such as the Qana Massacre, in 1996 as a pivotal moment. My Mum’s family is from Qana, and we used to spend our weekends and summers there. At that point I started to get interested in the ability to help patients and to look for opportunities. Soon afterwards, when I was 14 a family friend who was a plastic surgeon was going down to Sidon (a city 40km south of Beirut on Lebanon’s Mediterranean Coast) to do some reconstruction for some young trauma patients who had deformities in their legs from burns, contractures, and blast injuries. He was probably a bit surprised I wanted to go with him! But he was willing to take me which was great, I owe him everything for that.

I still remember the day. He picked me up at 6am in his jeep, and we drove down to the south and I saw him operating on these children and I think at that point, I just knew that this is what I wanted to do. I was mesmerised. After that, any time I could get into an operating room I wanted to see what was going on.

“Even now, I still love it. It’s very humbling, you are in an operating room, the patient is asleep, you have a team around you trying to make a positive difference in a patient’s life.”

I love all surgery and every case is unique in its own way; the patient and their journey. For me, it’s about holistic care, and how you fit within that. The whole approach, utilising both surgical and non-surgical techniques to complement each other in order to produce positive patient outcomes.

At the end of last year I spoke to Times Radio about the world’s first partial face transplant, which as a plastic surgeon is a remarkable source of inspiration to me.

Fifteen years ago French recipient Isabelle Dinoire underwent a 15 hour operation as surgeons transplanted the nose, lips and chin from a donor in Northern France. The pioneering surgery was a source of international interest and it has since paved the way for many similar complex procedures. What’s important to recognise about this landmark case is that it was genuinely groundbreaking. It was unknown territory. The first organ transplant (the kidney) had occurred back in the 1950s, but it took until 2005 for the first person to undergo a partial face transplant. The reason why it took so long was because this is a really complex part of the body, comprising myriad tissue components. This is also probably one of the most immunologically challenging tissues of all, which is why it took a long time for surgeons to feel comfortable doing this type of procedure. They needed to ensure the right processes were in place, and the right measures were taken to safeguard the patient.

The story itself is well-documented and very tragic but for me it’s a case study that showcases the power of reconstructive surgery.

To help restore form and function so that a person can continue to live their life. It is a reminder that plastic surgery is not just about aesthetics. It is based on the philosophy of repairing form and function, that could be a severe injury, like in the case of Isabelle’s, or it could mean addressing birth defects like cleft palate reconstruction.

It could be post-cancer reconstruction or resurfacing the body after a serious burn. Or bomb blast reconstruction or injuries encountered in warfare. The injured are often the forgotten casualties of any disaster, but plastic reconstructive surgery means people have a second chance. The injuries sustained in serious accidents can have lifetime consequences and a very significant impact on their quality of life. Severe nerve injuries, functional injuries, and extensive scarring will affect form and function; there is never a quick fix, but reconstructive surgery affords people an opportunity at a better quality of life, which is something I’m incredibly passionate about.

“Everyone’s story is unique, and everyone deserves a chance to lead their best life. The expertise and technology that is on offer now, is incredibly exciting for the future of reconstructive surgery.”