In 2013 a team of surgeons from Changsha, Hunan Province of China, reattached a hand—which had been severed because of an industrial accident—to the patient’s ankle. The Changsha hospital surgical team sewed the severed hand to the patient’s ankle so that the ankle’s arteries and veins could feed the hand’s mangled tissues. In that older case, the doctor explained their approach saying: “His injury was severe. Besides ripping injuries, his arm was also flattened. We had to clear and treat his injuries before taking on the hand reattachment surgery.”
The ankle’s blood supply kept the patient’s hand alive while his arm recovered. It took a month.
The patient literally walked his hand back into the hospital and the surgical team removed it from the ankle and reattached it to his arm. Because of his doctor’s innovative approach, the patient’s hand was saved.
And now a different surgeon in China has duplicated the Changsha team’s approach.
This time the surgeons are in Xiangtan, also in the Hunan province, and the patient, identified only as Shoum, lost his left hand in an industrial accident and the innovative procedure was performed Xiangya hospital in the provincial capital.
Tang Juyu, head of the hand microsurgery department at the hospital, told People’s Daily Online that instead of amputating Zhou’s hand, the surgeons decided to keep it alive by grafting it to his ankle so it could take advantage of blood from the arteries in the leg.
The patient’s hand had been severely injured, and the nerves and tendons needed time to heal before reattachment surgery. A month later, surgeons were able to remove the hand and replant it back on the patient’s arm.
Most accidental amputations result from the traumatic interaction of human limb and machinery. These high speed machines mangle, crush and rip limbs almost instantaneously which, to some degree, spares the patient some pain but creates incredibly complex repair problems for surgeons. Indeed, most of interactions between modern industrial machines and human limbs make reattachment impossible.
It has been 50 years since the first successful limb reattachment surgery and, as these cases from China illustrate, the problems have not changed. Just the solutions.
Fifty-three years ago, May 1962, 12-year-old Everett Knowles, Jr. tried to “hop a train” and missed. He fell and his shoulder landed under the train’s wheel where his arm was literally ripped off from his shoulder. The accident happened near Boston and he was rushed to Mass General hospital. The surgical team decided to try to reattach the severed arm.
Before Knowles, there had never been a documented case of a full reattachment of a completely severed limb on a human. On dogs, yes. But not humans.
Knowles, however, was a good candidate. He was young, His arm was on ice. So they went to work.
The team’s first concern was the health of the severed arm. It had not had blood supply for a while. How much was still salvageable? Immediately after cleaning the limb the team set about re-establishing blood supply and reconnected arteries and veins. That was the end of surgery #1.
Over the next few months, the team went back in again and again to systematically reattach bone, muscle, nerve bundles and skin. Nerves were attached last.
In the years that followed, Knowles regained use of his once-dominant right hand, and was eventually able to use it as well as a natural southpaw uses a right hand.
The team in China was faced with a much less promising candidate than 12-year-old Knowles from 50 years ago. As often happens with industrial accidents, the arm was severely compromised. So much so that restoring a blood supply was impossible. Unless….
There is an alternative, temporary source of blood to stabilize and restore the severed limb. Like an ankle.
