Forearm of 50-year-old man severed during factory work, regrafted in complex surgery

New Delhi: In a challenging surgery, a forearm of a 50-year-old factory worker, which had got severed while working on a machine, was regrafted at a leading hospital here, its doctors said on Thursday.

The ”extremely complex surgery” lasted about six hours, they said.

The man had sustained ”crush amputation of the right forearm”, just below the elbow, while working on a machine in the factory, the hospital authorities said in a statement. He was rushed to a nearby nursing home that did not have facilities for this serious case, so was then immediately taken to Fortis Hospital at Shalimar Bagh within 30 minutes of the incident, it said.

”Two teams of doctors led by Dr. Richie Gupta, director, and head of the department of plastic surgery at Fortis Hospital, Shalimar Bagh, performed the replantation surgery – an advanced procedure where bone, muscles, blood vessels, nerves, and tendons are accurately identified and sutured using microsurgical techniques,” the statement said. Timely presentation at the hospital and coordination among the plastic surgery, orthopedic, anesthesia, and intensive care teams ensured that the replantation was successful, the hospital authorities said.

Since his condition was ”extremely critical” due to hypotension and shock, no time was wasted in resuscitation and initiation of the surgical procedures, doctors said.

”Since this was an amputation case, there was a massive blood loss and we could have lost the patient, had there been any further delay,” said Gupta.

This case was different from a clean amputation, such as a sword injury, in which case the tissue damage is less. This case was crush amputation due to machine injury, and as a result, the damage to structures especially muscles was extensive. If not treated on time, it can result in permanent loss of an extremity, the statement said.

”Muscles die very quickly when there is a lack of blood supply. So, the surgeon has to figure out how to restore blood circulation to the amputated body part in the shortest time. During a replantation surgery, the arteries and veins are joined first, then the nerves, followed by the muscles and other tissues,” it added.

This surgery took around six hours, and after blood circulation was restored, doctors continued to monitor the patient in the ICU, especially for kidney damage due to toxins released from injured muscles, as well as sepsis. The patient was given four units of blood, and he was discharged in good condition, five days post-surgery. He still has some wounds, which may require skin grafting, doctors said.

The surgery took place in early July, a spokesperson of the hospital said.

”Replantation is an extremely complex surgery requiring close coordination among plastic surgery, orthopedic, anesthesia, and intensive care teams. Post-surgery, while the circulation resumes immediately, it takes around 300 days for nerve regeneration, and hence sensations and fine function to return. However, basic functions such as bending and straightening of fingers, as well as performing simple tasks can be started in six weeks of time,” Gupta added.