ATLANTA, Georgia (CNN) -- One Monday nearly a year ago, a 4-year-old Iraqi boy named Youssif was sitting outside his modest Baghdad home eating chips and playing when masked assailants doused him with gasoline and set him on fire. Their motive remains a mystery, but their violence left the boy's face horribly disfigured.
Youssif was horribly disfigured after masked men doused him with gasoline and set him on fire.
If Youssif had been injured in the United States, he'd probably have received skin grafts within days. But in war-ravaged Kindi Hospital in Baghdad, the treatment was less than state of the art.
Doctors scraped away dead tissue using a brush and a thin metal instrument called a debriding tool. The extraordinarily painful procedure kept the boy's wounds from becoming infected but left him with thick, raised skin where he'd been burned. The scar tissue pulled on surrounding healthy skin, restricting movement; Youssif could barely open his mouth enough to eat. A smile was impossible.
When California plastic surgeon Dr. Peter Grossman heard a news report about Youssif, he volunteered to help.
"Sometimes the situation you're presented with gets you right in the heart and you say, 'You know what? I want to do something. I want to reach out,' " said Grossman, whose father started the Grossman Burn Center in 1969.
Youssif arrived at the Grossman Burn Center in Sherman Oaks in September. By then thick scars had formed across his chin and jawline, around his nose and mouth, and in front of his right ear. Youssif also arrived with a dread of doctors.
"When I first saw Youssif, I saw a face that I had seen several times before," Grossman said. "I saw a young child, very scared. a glimmer of hope something could be done but not quite trusting. I knew from that moment that my work was cut out for me. Not only from a surgical level, but from a human level. How could I get this child to trust me?" Interactive: How Youssif's treatment has progressed »
The two main surgical techniques at Grossman's disposal were skin grafts and flaps. He has used both. On a personal level, Grossman said he needed time and results to build his credibility with Youssif and overcome the boy's fear of doctors.
During Youssif's first operation, Grossman inserted small balloons called tissue expanders in the boy's neck and right cheek. He inflated these slowly with weekly saline injections to stretch out the surface area of healthy skin adjacent to the now-5-year-old's scars.
Grossman also removed the scarred tissue around Youssif's nose, replacing it temporarily with cadaver skin. The cadaver skin was there to stimulate blood vessels for Youssif's graft four days later, using skin from his own belly.
Youssif also spent time in a hyperbaric chamber. The pressurized, pure oxygen helps wounds heal. Unlike the saline injections, Youssif enjoyed time in the glass-walled chamber, watching American cartoons or Disney movies on a wall-mounted television. Apparently, "Tom and Jerry" and "Aladdin" needed no translation.
Youssif's neck and cheek were bulging from the tissue expanders when he went into surgery for the third time on November 29. Grossman removed the expanders -- the one in Youssif's neck was now the size of a soda can -- and then cut away the scars on his face.
Grossman used the new skin to replace scar tissue that the surgeon said felt like wood. The operation also freed movement in Youssif's mouth.
Two big risks of burn surgery are bleeding and infection. After his most recent surgery, Youssif suffered bleeding under his flap twice, forcing the youngster back to the operating room both times. In each instance, Grossman had to remove 60 to 100 stitches and find the source of the bleeding. An artery was the cause in both cases.
As he began to heal, Youssif boasted that he was able to put a fork into his mouth and take "big bites," and he exulted in being able to see his teeth and stick out his tongue. Youssif also appears to be developing a bond with Grossman.
"I still feel I have a long way to go with him, both in improving his function and appearance and in gaining his full trust," Grossman wrote in an e-mail. "The day he comes into the office and runs up and gives me a hug will be the day I know that all the barriers have come down."
More surgery is on the horizon for Youssif, but already the scarring across his young face has been reduced significantly.
"You can never get rid of scars when you're burned. All you're really trying to do is trade one for another. Make one smaller. Make it better. Make it more cosmetically appealing," Grossman said.
On a recent outing to a park, Youssif ran around kicking a soccer ball and doing his best Spiderman impersonation. He also spent a good deal of time smiling. E-mail to a friend
David S. Martin is a senior producer with CNN Medical News.