Patna doctor restores severed wrist

PATNA: Tragedy struck Rakesh Pandey, 25, a farmer of Puchari under Baniapur police station in Saran district on December 27 last year as his right wrist was completely severed when his kada (metallic bangle) got stuck in a part of the fodder-cutting machine he was operating.
The incident could have meant deformity and disability that might have robbed Pandey of his livelihood, but thanks to Dr Birendra Kishore Sharma, a microsurgery surgeon, the victim can now look forward to a normal or near normal life.Dr Sharma successfully replanted the wrist through an operation which lasted for over seven hours. Now, Rakesh is undergoing physiotherapy to make the hand functional, again.
"Dr Mani Bhushan, an orthopaedic surgeon of Chhapra, contacted me after Rakesh was taken to him. We immediately instructed the patient's relatives to keep the severed wrist in a polythene bag in an airtight and watertight manner and keep it in ice or thermos with ice and bring it to us, along with the patient, at the earliest possible. Our team at Deepak Hospital was kept ready and after the patient reached us around 6.30pm, we started the operation which continued till 2.30am," Dr Sharma recalls.
"The success rate of such operations is only 80% and depends on a number of factors - age of the patient, type of amputation (clean cut, crushed, avulsion), ischemia time (time of reaching the plastic surgeon) and skill of the surgeon. The margin of error is very small and errors made technically cannot be erased chemically," said Dr Sharma, adding such operations are very demanding. He said since 1992, he had saved hundreds of hands, including about two dozen cases of completely severed hands."
"Surgery of the severed wrist was started with separation and identification of tendons, nerves and vessels (arteries and veins). Then the patient's tendons, nerves and vessels were similarly treated. After fixing of bones, first tendons, then nerves and then arteries and veins were joined. The next two-three days were very crucial as there was risk of veins and arteries getting blocked again, which could have necessitated re-surgery. However, the patient has now been discharged. With physiotherapy, it can take months for the hand to start functioning again," he said.
Dr Sharma underlined the importance of government-run trauma centres to handle cases of replantation (joining severed part) and revascularization (joining of partly severed part). "After brain, hand is the most important organ for earning livelihood. Most serious hand injuries are caused to working class people and, therefore, the government should work in this field," he said, lamenting that though the PMCH has a unit, it has no organized team to treat such serious cases.
PMCH's loss
Crass working of the health department led to the loss of what could have been the pride of PMCH. Dr Sharma was an assistant professor of plastic surgery in PMCH. But he was shifted in the role of an anaesthetist and posted for paramedical teaching. Realizing that his training in microsurgery could go waste, he sought voluntary retirement in 1998.
Cadaver transplant
Dr Sharma said with the expanding frontiers of medical science, transplantation of cadaver hands (of dead people) is also possible. Worldwide, about 150 such cases have been done. But government permission for the same is awaited in India.