Playing with the wheels of his father’s parked motorcycle, which was left idling, proved costly for four-year-old Pratik Sardar whose wrist got completely torn off when the exposed chain of the wheel cut into his hand.
Distressed, the boy’s father Dnyaneshwar Sardar, a primary school teacher and resident of a village near Nasrapur, immediately picked up the severed limb and put it into an ice bag and rushed his bleeding son to the Poona Hospital.
Facing a danger of complete amputation of the left hand and a lifelong disability, Pratik’s parents were hoping for a miracle. Their wish was granted when a team of microvascular surgeons at the hospital laboured for eight hours in a complex surgery to put together his wrist repairing the nerve, tissue and muscle damage.
The incident took place in December 2012 and the boy was back home in January this year but the hospital doctors waited for six months to check the viability of the arm. According to the doctors, the real test of their patience came the very next day of the surgery when a portion of the arm started turning blue.
“The blood circulation to the wrist had been established but due to the extensive damage to the hand, the veins of the replanted hand got blocked. That’s when the blood supply was affected and the hand started turning bluish,” recalled Dr Shrirang Pandit, plastic and cosmetic surgeon.
The boy was immediately taken up for re-exploration of hand by microvascular surgeon Dr Abhishek Ghosh. After painstaking reattachment of the vessels under a microscope the hand was finally saved.
“The patient has been doing regular follow-ups with the physiotherapy and so far he is able to move his fingers and lift and turn his wrist. It will take some time before his functionality is completely assessed but generally it could be between 35% to 50%. More importantly, the adverse psychological impact is averted since he has his own hand attached which is aesthetically pleasing,” said Dr Ghosh.
Doctors said that the most important thing is to get the severed limb to the hospital within six hours of the incident. “In this case, the patient reached within four hours and hence had better chances at success,” added Dr Pandit.
Surgery’s success
depends on many factors
l Nature of the injury such as crush or sharp cut injuries
l Warm ischemic time (duration between time of amputation and time of replantation)
l Age of the patient
l Smoking habits
l Pre-existing diseases like diabetes, site of injury, contamination etc.
What you should do in such an emergency
l Give basic first aid immediately
l Wrap the injured limb in a clean dressing and elevate it with direct pressure applied to limit bleeding
l Attempts to ligate arterial bleeding should be avoided, as this result in further injury to the vessels
l The amputated part should be retrieved
l Ideal time to reach hospital is 6 hours but it can be lengthened to 12 hours by wrapping the amputated part in a saline-moistened gauze sponge placed in a plastic bag. The plastic bag should be sealed and placed in a container of ice
l The amputated part should never be placed directly on ice because this could result in frostbite injury to the vessels
l The part should also never be immersed in water which makes digital vessel repair more difficult and less reliable
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