Improved microsurgery helps rejoin body parts

PUNE: Advancements in microsurgery have helped rejoin severed body parts with more precision. The procedure is done by restoring blood supply, repairing tendons, nerves, bones etc.
Recently, a 45-year-old woman, who cut her left thumb while working in a factory, and a 40-year-old man who lost his four fingers in an assault, reaped benefits of microsurgery at a city hospital.
A few months ago, Usha Gaikwad (name changed) of Hadapsar was injured in a factory and her thumb was amputated. After receiving first-aid from a private hospital, she was rushed to a private tertiary care centre within an hour. The amputated thumb was immediately preserved in cold storage and the re-implant procedure was started.
"She reached our hospital around 12 pm that day. We started re-implantation procedure from 2 pm. Blood supply to the hand was restored at 3.30 pm and re-implantation procedure was completed by 6 pm," said consultant reconstructive and cosmetic surgeon Sumit Saxena of the Inamdar hospital, where the procedure was carried out.
Similarly, Vibhas Shinde (name changed) cut four fingers of his right hand in an assault. "All finger
vessels, nerves and tendons were cut near the base of the fingers. The re-implant procedure was started immediately. The surgery lasted for 10 hours," Saxena said.
All wounds healed, the patient was discharged after a week. "After the discharge, there was a flicker of movement in the fingers. The patient was advised regular follow up to assess the bony union, range of motion, and nerve recovery," Saxena said.
But what factors add to the success of re-implant micro-procedures?
Success of such operation depends on factors like nature of the injury, such as crush or sharp cut injuries, warm ischemic time (duration between time of amputation and time of re-implantation), patient's age, smoking habit, pre-existing diseases like diabetes, site of injury, contamination etc, say experts. "Basic first-aid should be given immediately. The injured hand should be wrapped in a clean dressing and elevated with direct pressure applied to limit bleeding," said orthopaedic surgeon Purvez Inamdar.
Besides, attempts to ligate or tie up arterial bleeding should be avoided, as this result in further injury to the vessels. The amputated part should be retrieved, even if it seems unlikely that re-implantation is possible, he said.
When considering multiple-finger re-implantation, the finger with the best chance for successful re-implantation, best expected recovery and most significant contribution to function is repaired first. "If all the fingers are injured equally and have the same chance for successful repair, the order of repair should be the middle finger first, then index, then ring, and lastly the small finger," said Saxena.
The re-implanted part never regains 100% of its original use; most doctors consider 60% to 80% of use an excellent result. "In the procedures carried out on Usha and Vibhas, the functional rate has been above 80%," Saxena added.
Procedures for re-implant
The injured hand should be wrapped in a clean dressing and elevated with direct pressure applied to limit bleeding
Attempts to ligate or tie up arterial bleeding should be avoided, as this result in further injury to the vessels
The amputated part should be retrieved, even if it appears unlikely that re-plantation is possible
Ideal warm ischemic time (duration between time of amputation and time of re-plantation) 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 never be placed directly on ice because this could result in frostbite injury to the vessels.
The part should also never be immersed in water which makes finger vessel repair more difficult and less reliable. The time can be still lengthened in cases related to children.