An exceptional medical case that severely tested the skills and coordination of multiple surgical specialties was successfully managed by the team at Bacău County Emergency Hospital (SJU Bacău). The procedure aimed to save the life of a 52-year-old woman from a rural area, diagnosed with an advanced and aggressive form of invasive squamous cell carcinoma. The tumor had spread throughout the craniofacial region, infiltrating the eye and critical bone structures.
The patient was initially admitted to the Internal Medicine ward for an unrelated condition. During an interdisciplinary consultation, doctors discovered an extensive tumor, with the diagnosis confirmed through CT imaging and histopathological analysis.
„The diagnosis posed major challenges due to the invasion of the eyeball, sinuses, and craniofacial bones. A wide resection into healthy tissue was necessary, including complete removal of the eye, dura mater plasty — the membrane that protects the brain — and reconstruction of the affected area using live tissue capable of providing protection and nourishment to the exposed cranial zone,” explained Dr. Iulian Ghimiș, head of the Plastic Surgery Department and coordinator of the multidisciplinary team.
The complexity of the operation increased further due to the presence of an Enterobacter infection, identified through microbiological lab tests. Given the extent of tissue loss, which could not be covered locally, the team opted for an advanced reconstruction method: a free Latissimus dorsi muscle transfer, a complex vascular microsurgery technique.
„We connected the arteries and veins supplying the transplanted muscle to the superficial temporal vascular pedicle, with a diameter of just 2–4 mm. This step, performed under a microscope, was crucial for graft viability. Any failure at this stage would have jeopardized the entire surgical effort,” added Dr. Ghimiș.
The surgery lasted approximately six hours and was performed under general anesthesia, with the active involvement of the Neurosurgery, Ophthalmology, and Anesthesiology–Intensive Care teams. After 90 days of hospitalization and close postoperative monitoring, the patient was discharged in good condition.
„This case clearly illustrates the importance of a multidisciplinary approach and the high level of professionalism we have here at SJU Bacău. Through such interventions, we prove that we can offer highly complex treatments at a standard of excellence, not only for local patients but for the entire region,” Dr. Ghimiș concluded.
With this achievement, Bacău County Emergency Hospital reaffirms its status as a reference medical center, capable of managing extremely difficult surgical cases through a combination of expertise, technology, and teamwork.
