The Department of Plastic, Reconstructive, and Aesthetic Surgery at Sassoon General Hospital (SGH) and BJ Medical College (BJMC) recently performed a remarkable feat. The doctors successfully attached the hand of a 22-year-old man that was severed after it got stuck inside a dough-kneading machine, during a seven-hour-long surgery.
While operating a dough mixer in Baramati, the youth's hand got stuck in the machine, resulting in the breaking of his right arm between the elbow and wrist. He was immediately admitted to SGH. This was a case of avulsion injury that caused the muscles and nerves of the hand to be torn from the root.
The team included Dr Parag Sahasrabudhe, head of the plastic surgery department, Dr Nikhil Panse, professor of plastic surgery, Dr Ankur Karanjkar, Dr Piyush Bamnodkar, Dr Aditya Marathe, Dr Ranjit Patil, Dr Kaushik Das, Dr Pratik Pal, and Dr Sujit Kshirsagar. The surgery lasted for seven hours in the trauma operation theatre.
The avulsion-style amputation, coupled with the patient's delayed arrival, six hours post-accident, presented formidable challenges. Critical ischemia is the maximum period during which the blood supply to a human organ is cut off, even if the cells in the organ can survive with very little chance of recovery. This delay also increases the risk of damage to the kidneys, liver, and other organs, and may even lead to death from reperfusion injury (infection of toxins from dead cells into the blood). Considering all these possibilities, the team of doctors at SGH performed the replantation surgery after obtaining consent from the patient and the patient's relatives.
Using new techniques, the patient was given a special type of anesthesia—ultrasound-guided anesthesia in the veins of the patient's hand, which numbed the patient's arm despite being fully conscious. The complex procedure involved reattaching the arm's arteries, veins, and nerves with microscopic precision, and connecting both arm bones (radius and ulna) with metal plates. Four units of blood and two units of frozen plasma were given to the patient during surgery. After surgery, the patient was kept under observation in the trauma ICU for three days.
The patient's right arm was restored on the 15th day post-transplantation surgery. He is receiving daily dressings and antibiotic treatment, and plans are being made for future procedures to enhance the function of the hand, which will further improve the function of the patient's reattached hand.
