This time it is the left, whereas earlier it was the right.

Another major and complex full hand re-plantation has been performed once again at the Colombo South (Kalubowila) Teaching Hospital in mid-January.

The Sunday Times sees both patients – 47-year-old Malinbadagamage Saman Kumara who had his left hand re-planted, with bandage and all and able to move his fingers and Henagama Liyanage Ranjith Dayananda who proudly shows off his right hand and how it works having undergone that surgery back in April 2015.

Kumara had been the victim of a sword attack on January 9 in Padukka and as he shielded his neck with his arm, his hand had been completely severed. Many years earlier, Dayananda had been the victim of a workplace accident when his hand got caught and mangled in a machine.

“Menik katuwa lagin kepila giya (The hand got severed from the wrist),” says sword-attack victim Kumara, smilingly adding: “Den angili navanna puluwan (I can bend my fingers now).”

Consultant Plastic and Reconstructive Surgeon, Dr. Yasas Abeywickrama says that as soon as Kumara was transferred to Kalubowila, Consultant Orthopaedic Surgeon Dr. Arul Kumaran fixed the bones that were broken.

Thereafter, it was Dr. Abeywickrama’s team, including his capable juniors, Senior House Officers (SHOs) Dr. Bandula Ganiearachchi and Dr. Anura Wijesinghe, which took over to perform this medical feat.

Such surgeries are long and complex, says Dr. Abeywickrama, explaining that the full operation on Kumara lasted about eight hours.

The team cleaned the hand and the forearm stump, with thorough debridement of the contaminated tissue. An assessment of the tissue injuries followed, with the proximal stump and the severed hand being looked at under magnification. The bones, ligaments, tendons, arteries, veins and nerves were closely examined. Thereafter, they repaired the ligaments of the wrist joint as well as the arteries and veins under microscopic surgery. Individual tendons of the flexor (at the front of the wrist) and extensor (at the back of the wrist) were identified and repaired. Next they covered the soft tissue with the available skin-flaps and stabilized the re-plantation with a light dressing and a supportive splint.

Dr. Abeywickrama says that a major challenge in this type of re-plantation surgery is blood vessel anastomosis (surgical connection), which enables a “complete” repair, making the limb functional. This is while the nerve repair is equally important for sensation and small muscle function.

While we are chatting to patient Kumara and the doctors, Dayananda interacts with the nurses as if he has come to his second home.

With Kumara still unable to properly vocalize his thoughts about the life-changing full-hand re-attachment performed on him, it is Dayananda who underwent the first such surgery who hands out the laurels. After showing off the prowess of his re-attached hand to carry weights up to 10kg, he simply says: “Jeevithey beruwa, manasa haduwa, atha apahu dunna (They saved my life, built up my mental strength and gave me back my hand).”

He still remembers how Dr. Abeywickrama kept patting him on the head, reassuring him: “Atha hai kara (We have re-attached your hand).”

(The Sunday Times in its ‘PLUS’ section exclusively reported Dayananda’s story headlined ‘To hold up a hand that’s whole again’ on April 19, 2015)

What should be done

Here are some words of advice from Consultant Plastic and Reconstructive Surgeon, Dr. Yasas Abeywickrama, in the unfortunate event of a person facing an emergency of a limb severance. “The first and foremost requirement is to go to the nearest hospital taking the severed limb with you immediately,” he says, stressing that the sooner the better. This is due to tissue damage of the limb starting by six hours unless cooling is done. The do’s and don’ts are: Transport the patient along with the severed limb under dry conditions as soon as possible, ideally within six hours, to hospital. Place the limb in an empty polythene bag and seal it. Then place the polythene bag in a box and surround the polythene bag with plenty of ice-cubes. The severed limb should not come into direct contact with the ice as there would be frost-bite. It should also not be directly immersed in any type of liquid including water as it would affect its metabolism causing damage to the intima (inner layers) of the blood vessels, making them prone to thrombosis (blood clots). The severed limb should also not be tightened or squeezed. Do not tie a tourniquet to the arm but wrap the cut-end tightly with a cloth. It would be good to inform the hospital in advance when a victim of any such limb injury is being brought there, so that the relevant multidisciplinary teams could be on standby for the victim’s arrival.

 

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