25 June 2010

SA man's severed arm reattached

As the final whistle blew signalling the end of the soccer game between South Africa and France a surgeon inserted the final suture in a once severed limb in a theatre in Durban.


As the final whistle blew signalling the end of the soccer game between South Africa and France on Tuesday evening a surgeon inserted the final suture in a once severed limb in an operating theatre in Durban.
The tension in the theatre visibly eased. Finally the gruelling nine-hour procedure, during which a team of surgeons meticulously reattached a man's spontaneously amputated arm, was successfully completed.
Three days after the procedure 37-year old Alfred Henery is described as being in a serious yet stable condition at Netcare's St Augustine's hospital. Augusta Dorning, General Manager of the hospital attributes the successful reattachment procedure to the quick response by the Netcare 911 emergency crew and the team of dedicated healthcare professionals at the hospital who worked tirelessly for nine hours to reattach the severed arm. "The first 48 hours were crucial," Dorning said. "Right now the patient is awake, comfortable and in good spirits. His medical team will continue monitoring his progress before making a more definitive evaluation of his condition."  
Alfred's fiancée Edith-Ann has been by his side since the accident. She explains that before Alfred left for work that morning he took some chicken out for dinner and how it was the very first thing he mentioned when he woke up in hospital. When he left the house that morning Alfred was not to know that he would spend his day in an operating theatre and that he would not be eating chicken that night or get to see the heroic performance of Bafana Bafana in Bloemfontein. Instead he had become the leading man in a real-life drama that would change his life forever.  
Yesterday Alfred, a yard supervisor, recounted the traumatic scene that played itself out at work on the fateful day when he stuck his hand into a conveyer belt to clean it. From his hospital bed he explained how when he reached into the mixer his clothing was caught in the machine. Within a split second his arm was mangled and spontaneously amputated at the elbow. Initially he did not realise that the arm was severed. That only dawned upon him as he looked down and saw the severely damaged limb lying at his feet.

For Alfred the moments that followed are somewhat blurred. Safe to say some quick thinking and effective action ensued and before he knew what had hit him a still joking Alfred was in the back of a Netcare 911 ambulance with his severed arm safely packed on ice.
At Netcare St Augustine's Hospital Trauma Surgeon Dr Kevin McEwen immediately assembled a team of experts that included: General Surgeon - Mr Gert du Toit, Orthopaedic Surgeon – Dr Gabriel Pirjol, Cardio Thoracic Surgeon – Mr David Shama and anaesthetists Dr Kobus van Aswegen and Dr Oliver Ludwig who stood by to monitor the condition of the patient and to prevent the onset of reperfusion syndrome, * which could have cost him his life.
"There is a four-hour window period following amputation during which surgery should be performed in order to prevent the muscles from dying – in this case we were well within that period," he says. "However, bits of vein and arteries were torn when the arm was severed which made the task at hand a difficult one. Over and above that the toxicity of the severed limb is a major risk."
During the heroic attempt to save Alfred’s arm the specialist team harvested a vein from his groin. They reconnected blood vessels one by one in order to restore blood flow and oxygen that would bring life back to the injured limb. After the arm turned pink and a pulse returned to the wrist the doctors reattached the nerves. In the weeks that follow Alfred, who was planning his wedding to Edith-Ann just days before, will be receiving life-saving hyperbaric treatment every day. The hyperbaric treatment is crucial in detoxifying his arm and is highly effective in reducing the risk of infection.
McEwen explains that the reattachment of a limb is a lengthy microsurgical procedure, which involves using microscopic magnification to painstakingly restore, repair and reconnect the blood vessels, muscles, tendons, nerves, and other soft tissues and the alignment of bony structures. Several surgical procedures are generally needed and the prognosis is sadly not always a good one.  
"The first step in reattaching the arm was to restore blood flow by reconnecting the arteries. The veins must also be reattached and opened in order for the blood to flow from the severed limb. Swelling is a constant danger as it can cause tissue damage – that is why a conduit for outflow is an imperative. The procedure is painstakingly slow and detailed and impossible without the aid of microsurgery, which is surgery performed on very small structures, such as blood vessels and nerves, with highly specialised instruments under a microscope," explains McEwen.
McEwen says that this type of surgery is complex and that it therefore does not occur that often. "Reattaching an arm is rare – especially with this particular injury being in the region of the elbow where there are more vessels and nerves. Movement in the elbow and wrist is key in order to ensure that the patient will regain some form of functionality of the arm."
"The speed of repair is extremely slow as the injury was extensive and complex. Recuperation can therefore take a long time. A long road lies ahead for Alfred during which he will require other procedures. Even then and despite our very best efforts total success cannot be assured," concludes McEwen.

Information supplied by Martina Nicholson Associates (MNA) on behalf of Netcare St Anne’s and St Augustine's Hospitals


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