Severed hand re-attached

2005-10-28 21:08

Durban - Peering through a microscope a Durban plastic surgeon worked for seven-and-a-half hours re-attaching a severed hand at the city's St Augustine's Hospital on Friday morning.

A 25-year-old employee of a paper company had his left hand severed across the palm by a paper-cutting guillotine on Thursday evening.

"He was cut with a guillotine blade that cuts thick wads of paper, it's like a surgical knife blade. If you're going to have your hand cut off, that was probably the best way, unlike with a panga or a crushing machine. When there's a crush component it makes it unlikely that the limb will survive," plastic surgeon Dr Paul McGarr said.

He said amputation injuries were "quite uncommon". It was the first injury of this nature this year he had seen. In 2004 McGarr last dealt with one.

McGarr began the micro-vascular surgery at 18:00 on Thursday and worked until 01:30 on Friday. He first screwed and plated the man's bones into place before reconnecting the two tendons of each finger, followed by the two digital nerves for each finger.

"The most important thing is to reconnect the blood supply. As you go from the wrist to the fingertips the blood vessels get smaller and smaller and are about 1.5mm in diameter.

McGarr said the most challenging part of the operation was joining up the blood vessels using a nylon thread finer than a human hair.

Only smoked one cigarette a day

"It's like pulling two ends of string together."

McGarr said factors in the patient's favour were his age, his good health and the fact that he only smoked one cigarette a day.

"Smoking causes the vessels to go into spasm. They can just 'clot-off' and then the implant doesn't survive."

The man was also lucky to get to hospital within 30 minutes of his injury.

"What was different about this case was that we put the part into the same solution as you use for kidney and heart transplants. It's physiologically friendly. It helps prevent the part from drying out. We also flushed the blood vessels with this fluid before taking him to theatre."

The operation was two-thirds of the journey towards recovery, McGarr said.

"It needs a lot of hard work from the patient to get those fingers moving again. Assuming it all comes right he should have about 80% use of his hand."

McGarr said he worked alone, with only an anaesthetist present, as most of his colleagues were out of town at a plastic surgery congress. One had broken his arm, another was in Bloemfontein.

"It's not something one person can't handle. I love the work, I love the challenge.

"It's very satisfying to you see your result immediately. You're making a huge impact on someone's life. Without this he would potentially have been unemployable."

- SAPA