Dubai: Quick thinking and timely intervention by highly skilled micro-vascular and hand surgeons at Dubai’s Rashid Hospital in Dubai have helped save an elevator mechanic’s forearm that got severed in a freak accident recently.
The severed forearm fell all the way from the 26th to the fifth floor of a city hotel where the mechanic, 33-year old Flertin Baby from Thrissur in Kerala, was fixing a malfunctioning elevator on September 28.
In an exclusive interview with Gulf News, Baby said: “I was on the 26th floor in the elevator shaft trying to do some repairs when all of a sudden, the metallic cable of the lift gave way and came crashing on on my left forearm, completely severing it from my body. It fell right down to the fifth floor where the lift stood.”
He said, “I was in complete shock but I remember my colleagues shouting for help. Luckily, we had a male nurse on site who immediately called the ambulance and also asked for my forearm to be retrieved from the fifth floor. It was placed in an ice-box, even as I was rushed to the emergency.”
Time was of essence in reattaching the limb and restoring blood supply to it.
Dr Hamed Badawi, consultant hand surgeon at Rashid Hospital along with his colleague Dr Mohammad Ali, specialist orthopedic surgeon, who had been informed about the mishap, were waiting at the trauma centre for the ambulance to arrive.
Dr Badawi said: “The timing in such cases is extremely important, as is the condition of the severed limb. The surgery has to be carried in less than four hours after the accident. In this case, the patient was in the operation theatre in an hour’s time (7pm)and the most important thing was to repair the severed artery and restart the blood supply.
"Teamwork and planning helped us and we grafted a branched vein from the patient’s leg to create an arterial anastomosis (new blood supply channel) and repaired the artery. We restored blood supply by 10.30pm.”
The surgery then continued until 5.30am the next day as a team of doctors from the Hand and Microsurgery Unit at Rashid hospital worked on several layers of vascularisation and repair and reattachment.
Dr Ali said: “Our priority was repair of the main artery and restoration of the blood supply using the vein graft. After that, the severed bone was reattached using plates and screws. Then the muscle had to be repaired and the radial, ulnar and medial nerves also repaired.”
The team worked on intricate reconstruction of the minute structures within the hand.
Efforts pay off
The painstaking effort paid off as the patient was able to get back the sensation back in his hand and in the last three weeks. He has been started on light exercises to stretch the fingers and the muscles.
Dr Badawi said: “The patient’s hand will be in a plaster for another 10 days for the bone to get repaired, after which we will start him on aggressive rehabilitation. Physiotherapy will include electric shocks to stimulate the muscles in the region, and several intensive exercises to mobilise the arm and restore a complete range of motions.
Baby was discharged on October 16 to carry on the rest of his rehabilitation from home. His wife, Rose who was in Dubai on a visit to look for a job, has since devoted herself to her husband’s care.
“I had got my two-and-a-half-year-old son Nathan to meet his father, but after this accident I had to send him back with friends to be with his grandparents in Kerala. Doctors said the patient would take at least a year for his arm to perform complete motor functions.
The team of Hand and Microsurgery Unit at Rashid hospital under direction of Dr Khalid Alawadi, consultant hand and microsurgeon, get cases of severed digits every other day and limb amputation as a result of mishaps at least once a month.
“Limbs or digits amputated in industrial accidents can be saved provided there is a site supervisor and nurse who understand and are trained to manage such mishaps,” said Dr Badawi.
Cold Ishemia key to preserving severed organs
Dr Badawi said it is important that the severed digit or limb is brought as soon as possible to the hospital and is kept clean and viable to make it fit for reattachment.
“If people come across such a crisis, the first step would be to retrieve the amputated part, wash it with saline water. If saline water is not available, clean water at normal temperature is acceptable. Then the severed part must be wrapped in a clean gauze or fabric, placed in a plastic bag and then in an ice-box.”
The doctor warned that the severed limb or digit must not come in direct contact with ice. “The goal is to keep the amputated part cool, but not to cause more damage from the cold ice and if it is transported in this manner within four hours, the chances of reviving all functions is high. The blood supply must be restored within this period for the organ to get back full functions,” said Dr Badawi.
This method of transporting a severed organ is also used in transplants and is called cold ischemia. The ischemia is the time between the chilling of a tissue, organ or body part after its blood supply has been reduced or cut off and the time it is warmed by having its blood supply restored. This helps preserve the tissue of the organs from deteriorating.”