Katie Piper was the subject of a revenge attack in March 2008, when on the orders of Daniel Lynch sulphuric acid was thrown into her face. Katie has spoken widely about her ordeal, and her remarkable recovery, which is testament to a pioneering new procedure performed by Mr Mohammed Jawad, can now be reported in detail. It holds enormous potential for burns victims and could be a genuine alternative for potential face-transplant patients."When I first saw Katie, I was deeply concerned," says Mr Jawad. "Her face was swollen and an orange-brown colour from the acid. Her eyes were welded shut." At some points, the acid had burned down through four layers of skin to the fat itself. "Katie was temporarily blind in both eyes through corneal damage, and acid that she had swallowed in the attack had corroded her oesophagus making it difficult for her to swallow even her own saliva. But although she was conscious, she was not overcome by pain – she was numb on her face as the acid had burned deep into her nerve endings."After consulting with world leaders in reconstructive surgery, Mr Jawad decided to use a new second-generation dermal substitute called Matriderm. Invented just three years ago, these sheets of collagen and elastin fibres – the building blocks of all stretchy tissue in the body – provide scaffolding for new cells to grow through. Over it, he would apply a graft using skin harvested from her lower back and buttocks. This new artificial skin has been used in small patches under skin grafts to help the skin attach to the layer of fat below, but no one had thought to use it in such a dramatic way before. Mr Jawad intended to use it all over Katie's face – to encourage growth and ensure that her face had the same shape and contour as before. Without it, Katie's face would have healed, but grafted skin shrinks over time and can result in a very unnatural look. About a week after the attack, when Katie's wounds were healthy enough, Mr Jawad and a team of eight, including four surgeons, began the six-hour operation. "We began by making basic paper templates for the artificial skin and then cut it to shape. Once it is put in place, it sits like blotting paper, soaking into the layer of fat, and what was left of Katie's healthy skin. We added the skin grafts, meticulously sewing in hundreds of tiny sutures. It was tense; no one knew how it would work; and there was no second chance at getting it right." After four days, Katie's dressings were changed. "When I saw how well her face was doing, I was very relieved. I can't praise the ITU team highly enough or my own staff, and everyone in the burns unit," says Mr Jawad. "We really all did work together to get the best outcome for Katie."Just three weeks later she was ready to be discharged. Since then, Katie has recuperated well. She has undergone 30 procedures on her oesophagus to clear blockages, which result from scarring. These involve Dr Martin Benson in endoscopy putting a tube down her throat, using a balloon to force through a new passage. How far her skin will improve remains to be seen. "I think we have had a fantastic result so far," says Mr Jawad. I'd like to inject a little fat in places later to improve the appearance by adding volume. We can also draw some of Katie's blood, spin it in a centrifuge, make it into a gel, and then inject it back in like a filler." Read more at the Katie Piper site at http://www.katiepiper.co.uk
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