Monday, October 19th, 2009

Successful Micro vascular Surgery Saves a Man’s Hand

Brij Mohan's image

At about 8 pm on 20th April, 2009 Brij Mohan‘s hand was severed off his wrist after his hand accidentally came under his sheet-cutting machine. Thanks to his fellow staff and the primary physician who could make to the hospital well in time with the properly preserved severed hand. The operation started within two and a half hour of injury. After surgery lasting for more than 8 hours, Dr Raman Sethi and his team were able to fix the hand, restore circulation as well as repair all the tendons and nerves. Now almost a month has elapsed with good circulation of the replanted hand, it is quite sure that Brij Mohan has got his hand back which, for once, destiny had taken away from him.

Dr Raman explained that success of such operations depends on the type of injury, whether sharp or badly mutilated, level of injury, time elapsed in transportation, the proper method of storing the severed part and the availability of surgical expertise and facilities.

Micro vascular surgery pertains to joining of a few mm or sub mm size blood vessels so as to re-establish blood flow through these vessels. This is done under magnification using specially designed micro instruments and very thin sutures (many a times thinner than the hair shaft). Primary use is in replanting severed limbs or parts, apart from soft tissue reconstructions and post cancer surgery reconstructions.

Some facts related to Plastic & Micro vascular surgery

• The part should be wrapped in a wet gauze piece or cloth and kept in a poly bag or container made airtight and this container is to be kept in a bigger container containing ice/cold water.
• Patient should be immediately rushed to the centre specialized in such surgeries without wasting time.
• This technique of Microvascular surgery is being used in saving a lot other limbs also which would have landed up into amputations due to loss of large amount of skin over fractured bones. This technique is also used in restoring post cancer surgery defects like large facial/ jaw defects or post breast reconstruction.

Who is not an ideal candidate for this surgery?
Heavy smokers and patients with atherosclerotic disease or peripheral vascular disease in general are not ideal candidates. Secondly time elapsed since the injury – about 18 – 24 hrs in case of below wrist amputations and 12 hrs in case of above wrist if the part is properly cooled and preserved and 12 hrs and 6 hrs respectively if the part is not well preserved and cooled. Apart from these in trauma or amputations where the part is badly crushed usually we don’t attempt microvascular replantation or reconstruction

Recovery period
Recovery period depends on the situation – in case of replantations healing is usually complete by 2 -3 months including bony union and functional rehabilitation by 4-6 post traumatic and post cancer surgery reconstruction specially in breast and oral cancers

Risks involved

Risks mainly pertain to failure of microvascular anastomosis, which in selected cases carries a very low incidence. apart from this risks of lengthy anaesthesia and general operative risks like infection, bleeding etc are there which are comparable to any other surgical procedure

Alternative to Micro vascular surgery

In amputations, prosthesis is the only other alternative. In microvascular reconstructions although we can use other reconstructive alternatives like pedicled flaps or tissues adjacent to the defects.

With inputs from- Dr Raman Sethi.

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