Pure face emerging from scars of war
War's wounds can happen all at once, in a few minutes, as flames sear a child's tender skin. That was the case with 15-year-old Jennifer Anyayo, who six years ago suffered severe burns to her face, chest and left arm. She is just one of the victims from two decades of fighting in her native northern Uganda.
Her wounds are being repaired in small steps that make big differences.
On March 8, Craig Dufresne, a reconstructive and plastic surgeon at Fairfax Hospital, INOVA Health Systems, in Fairfax, Va., operated on Jennifer for the second time since she came to the United States on Dec. 24.
The young girl was much more at ease before this procedure. She laughed at jokes with her beloved "Uncle" Aaron Odongkara, a member of the family hosting her in Philadelphia. Odongkara's mother, Abitimo, is Jennifer's guardian in the United States.
I met Jennifer in Uganda while reporting on the civil war there. Arrangements were made for her to come to the United States, live in Philadelphia, and travel to metro Washington for surgery.
During the first procedure in January, Dufresne placed sacks called tissue expanders under her scalp and chest skin. In the following weeks, he injected saline solution into them to create tissue he would use to rebuild her face.
As it turned out, the procedure would net Dufresne more tissue from her scalp than from her chest, where the incision opened prematurely and the expanders slipped out. But he is a calm, skilled surgeon admired by his colleagues. He was disappointed, but determined to do as much as he could.
So were others at the hospital who know Jennifer's story. Asma Yassin, a native of war-torn Somalia, was at Dufresne's side as the surgical technologist.
"I feel bad for her," she said. "I know what war is like. "
The surgery began about 1 p.m. Dufresne removed the scalp expander and gently tugged down the new tissue. Jennifer's hairline, which had been burned off to the top of her head, moved lower.
Small motions by Dufresne; big differences for Jennifer. Soon, her hairline was mostly back to where it had been before the attack.
Elan Reisin, another surgeon, removed nasty scar tissue on her chest. It wasn't easy. Scar tissue is like rock.
Dufresne next turned to Jennifer's cheeks. Scarring had pulled her skin away from her eyes, leaving them with little protection.
He made small incisions around her nose and created small pockets under the skin. Into these, he slipped specially shaped high-density polyethylene implants and attached them to bone with tiny screws.
Suddenly, Jennifer had cheeks - a supermodel's cheeks, thanks to the implants that eventually will become part of her body.
Dufresne pulled up the extra chest tissue to loosen her cheek skin and give Jennifer an unscarred chin.
Loosening her cheeks may be the most important thing he did for her that day: The newly flexible skin should protect her remaining eyesight.
Finally, the doctors used expanded scalp tissue to begin rebuilding her nose. They make progress: Jennifer now has a distinct nose bridge.
By 3:30 p.m., the surgery was done. Dufresne will decide his next steps later.
Jennifer was in more pain than after the first procedure. But when she returned to Philadelphia two days later, she was jubilant.
Many wounds remain. But I am struck by how these surgeries slowly are revealing the pure face of a 15-year-old.
Carolyn Davis is a member of The Inquirer's Editorial Board.
For previous stories, audio, photos, Carolyn Davis' diary, and background on Jennifer Anyayo, go to http://go.philly.com/jennifer. Contact Carolyn Davis at 215-854-4214 or cdavis@phillynews.com
ONLINE EXTRA
For slideshows and updates chronicling Jennifer's journey, go to http://go.philly.com/jennifer
