Doctors surmount many challenges to save man hanging by a thread

Bengaluru: BGS Gleneagles Global Hospital gave a new lease of life to Jitendar Sen, a 28-year-old man who suffered a severe traumatic injury on his right arm when a sharp, heavy glass frame had fallen on his right elbow. It was a grave challenge for the doctors because the focus was not just to save his hand but also his life. A team of plastic & hand surgeon, ER and anesthesia immediately resuscitated the patient in an emergency room to stabilize his health condition, and later he was moved to the operation theatre to bring him back to life.

Jitender was admitted to the hospital on February 3 in a very feeble condition. He was bleeding profusely and lost about 3 litres of blood. He was in a terrible state of shock, his blood pressure was low and pulse was weak. The injured right hand showed no sign of viability, as blood was not flowing to his hand.

The wound over right elbow was examined under tourniquet control. The structures over anterior compartment of limb were completely cut including muscles, nerves and vascular structures. The only connecting tube which is brachial artery supplying blood to forearm and hand was cut at elbow level.

Now, challenge for the doctors was to make the blood flow to distal hand within six hours of injury. However, there was already a delay of 2 hours in shifting the patient to the OT as patient was not brought to the hospital immediately after injury. Dr Naveen Kumar, who is the hand and plastic surgeon, had only four hours left to bring back the blood flow.

The second challenge for the doctors was to cover the gap of 15cm between the cut ends of artery. This was bridged by taking vein from the leg. This vein acts as conduit to supply blood from proximal to distal segment. The entire surgery of exploring the wound, identifying structures, preparing proximal and distal ends of cut artery, taking vein from leg to bridge the gap, connecting the vein to both ends of artery under magnification using 8-0 prolene suture was completed in the span of 3 hours. Soon after releasing the clamps, blood was made to reflow to the hand successfully within six hours of golden period from the time of injury. Dr Naveen Kumar H R, consultant, cosmetic surgery, BGS Gleneagles Global Hospital: "Appropriate first aid within the golden hour can save lives of accident victims. Any bad injury resulting in total detachment of body parts like fingers, hand, and leg, should be reattached within the "golden period "of six hours."

"If any bystander witnesses such incidents one must make sure the person is breathing well and try to palpate the distal pulses of hand and feet. If it is not palpable, immediately close the wound with a clean cloth with moderate pressure, so that bleeding stops and shift him to a nearby tertiary care hospital."

"In case the part of the body is completely detached, then it should be wrapped in a clean wet gauze cloth and keep that cloth inside a container containing ice cubes and carry it with the patient to the nearby hospital."

The third challenge was to keep the patient stable throughout the procedure by giving blood and fluids. Though the blood pressure was low initially, it later picked up gradually as the surgery was progressing. It took another four hours to repair all the bruised muscles and nerves. Post his surgery, the patient was monitored in Intensive care unit. Hand perfusion was monitored constantly and a few more units of blood were transfused.

The patient was stabilized and shifted to the ward after 48 hours of observation. He was discharged from the ward after 4 days and was advised for continuous follow up for physiotherapy exercise.