Surgeons save hand after double level amputation
Wednesday August 28th, 2019
Surgeons have told how they successfully saved a patient's hand following a double-level amputation.
Two plastic surgeons at St George's Hospital, London, worked together to save carpenter Anthony
Lelliott's hand, which was severed at base of the palm and beneath the fingers following an accident
with a mechanised saw.
Surgeon Roger Adlard, who had previously only worked on "three or four" hand amputations took 13 hours on the operation to save the hand. Microsurgeon Farida Ali came into work to assist although she was not on call.
They then worked with a hand surgeon on a pedicled groin flap, leaving the hand attached to the groin for two weeks to allow skin to regrow.
Mr Adlard said yesterday: "In that first operation I wanted to re-attach and get blood and nerve supply to as many of the fingers as possible. After fixing the broken bones we harvested nerve and vein grafts. This involved taking veins from his foot and nerves from his forearm and using them to bridge the gaps between the structures in his hand.
“If it was a straight single cut it would have been much easier. We would have been able to join things directly together instead of having to take parts from elsewhere to replace the swathe of tissue that was missing.
“Farida and I took it in turns, with one of us taking veins from his foot and the other stitching the veins to arteries in his hand using a microscope and a very small needle. Every microsurgical repair takes a lot of concentration, so it was useful to be able to alternate between two surgeons. We did the same thing for his nerve grafts harvested from his forearm and I repaired any tendons that I could.
“Following the operation, we noticed some of the skin on his palm wasn’t surviving and what’s more, his middle finger had insufficient bone stability or feeling to it, so we made the decision that to save the rest of his hand, we’d sacrifice his middle finger and effectively fillet it to help reconstruct the skin and bone which was missing from his palm. This was performed by my colleague, Miss Sonja Cerovac.”
He added: “The next problem was there wasn’t enough skin to cover the exposed delicate microvascular repairs in his palm, so we decided to attach his hand to his groin to borrow skin from there. This procedure is called a pedicled groin flap and was performed by another hand surgeon, Mr Jamil Moledina.
“Mr Moledina cut a section of skin in Anthony’s groin and lifted it like a flap to cover the missing skin from his hand. It was sewn in place and left there for two weeks. Eventually the skin from his groin grew new roots to where it had been transferred to his hand and we were able to cut his hand free.”
The patient has already regained some movement in the hand, one month after the procedure, the hospital said.
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