Three years and multiple surgeries later, AIIMS Delhi became the first hospital in India to build a new forearm for a 27-year-old patient.
In November 2019, a factory worker from Uttar Pradesh’s Saharanpur came to AIIMS Delhi after his left arm suffered a severe injury: a hydraulic pressing machine crushed his forearm. The injury caused heavy damage to the skin, muscles, bones, soft tissue, and nerves. While the area from the elbow joint to the wrist was heavily injured and required immediate medical attention, the rest of his hand was relatively okay.
A team led by Dr Maneesh Singhal, head of the plastic, reconstructive and burns surgery department, evaluated the complicated case and concluded that hand replantation would be impossible because the forearm was unsalvageable. Since surgeries are possible if the patient is given medical attention within six hours, and because the man came to the hospital within time, the medical team had two options to proceed and help this man get a functioning arm.
The two options, in this case, were to reconstruct the forearm, or remove the damaged forearm and attach the palm to the rest of the hand – which would have shortened the length of his hand. So, the medical team decided on the former.
The palm was then cut off and attached to the left leg near the ankle. “We need to maintain sensation and continuity of the palm, so it was placed on the leg. If it had been placed in any other body part, it would have lost sensation. When the hand was again placed back, we took the same nerves of the left leg. Also, it was easy to find the bones in the leg to attach the palm temporarily. We chose the leg as there are extra nerves and blood vessels and muscles near the calf muscles”, said Dr Raja Tiwari from the plastics and burns surgery department.
When the palm was cut off, the crushed part of the hand too was cut off immediate;y after. The open elbow wound was sutured back. To create the forearm anew, two tissue units from the leg were used: a free fibula bone flap, with functioning muscles and nerves, and a thigh muscle, nerve and skin unit. The next step was to detach the palm from the left leg and attach it to the new forearm unit. The final step was tendon and nerve repair. Because pandemic created geographical barriers, the rebailitatiobn was done via tele-programming.
Dr Shashank Chauhan and Dr Suvashis Dash from the department of plastic surgery, Dr Samarth Mittal from orthopedics, and Dr Sulagna from the anaesthesia department comprised the medical team for the path-breaking surgery.
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