Shija Hospital replants amputated hand
Source: Hueiyen News Service
Imphal, February 14 2011:
With the advancement of micro-surgery, it is now possible to replant a totally amputated hand by restoring blood supply and repairing tendons, nerves, bones etc.
Shija hospital, has successfully replanted an amputated hand on February 5, the fifth time it has done so.
This time the fortunate person is Khaidem Warjit (25) from Mayang Imphal.
Warjit was assaulted with a sharp weapon at multiple parts on his body amputating his left wrist joint around 12:30 pm on February 5 at a remote paddy field.
After getting first aid from a local health centre, he was admitted at Shija Hospitals, Langol at 3:40 pm on the same day.
Replant procedures could not be started immediately as his blood pressure was not recordable because of excessive bleeding, stated a press release of the hospital today.
However, his amputated hand was immediately preserved in the cold storage at 40C and five units of blood were transfused.
A team led by Dr Kh Palin, Consultant Reconstructive and Cosmetic Surgeon, Shija Hospitals started replantation procedure from 6 pm, blood supply to the hand was restored at 8.30 pm and replantation procedure was completed by 11 pm.
Subsequently, another three units of compatible blood had to be transfused as his haemoglobin level was low.
Eight days after the hand still survives.
Dr Ronald Malt performed the first of such replantations on May 23, 1962 at Massachusetts General Hospital on a 12-year-old boy who had his right arm amputated in a train accident.
Since then, thousands of severed body parts have been reattached, preserving the quality of life for thousands of patients through improved function and appearance .
Success of the operation depends on factors like nature of the injury like crushings or sharp cut injuries, warm ischemic time (duration between time of amputation and time of replantation), age of the patient, smoking habit, pre-existing diseases like diabetes, site of injury, contamination etc.
The mechanism of injury may be the most predictive variable for successful replantation.
Studies have demonstrated significantly higher success rates with replantations of guillotine (as in Warjit's case) versus avulsion amputations.
Ideal warm ischemic time is 6 hours.
But it can be lengthened to 12 hours by wrapping the amputated part in a saline-moistened gauze sponge placed in a plastic bag.
The plastic bag should be sealed and placed in a container of ice.
The amputated part should not be placed directly on ice because this could result in frostbite injury to the vessels.
The part should not be immersed in water which makes digital vessel repair more difficult and less reliable.
The time can be still lengthened in cases related to children.
For emergency transportation, helicopter ambulance service is needed in a place like North Eastern India if the incident happens in remote location to salvage the hand, it further added.
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