Replantation miracles: Going out on a limb for people who lose theirs

If you lose a hand or foot in an accident, it can be reattached if surgery is performed quickly.

KARACHI:

Mohammad Shakir walked in to the seminar – a miracle for a man who was found separated from his two feet after an accident at the Steel Mills in 1996. 

It took seven and a half hours under anaesthesia for orthopaedic surgeon Dr Syed Mohammad Ali Shah to painstakingly reconnect his arteries, veins, muscles, nerves and joints.

Small wonder, then that Shakir has become a walking and talking advertisement for replantation surgery. He was invited to a seminar held by Dr Essa’s Laboratory and Diagnostic Centre in North Nazimabad on Saturday for its continuing medical education. “Replantation is a very skilled job as you not only have to replant but also make a limb refunction,” said Dr Shah.  Moreover, there is no room for mistakes.

He cautioned that the success rate is low and malpractice is rife. Even in his own practice, only 35 out of 53 surgeries have been successful. The situation is much worse in other countries which do not have this science. “For instance, there is no replantation surgeon in Dubai, or even in our capital city,” he shared.

In Pakistan, amputations are mostly caused by road traffic accidents, followed by those in factories, at home, at the railways and then there are gunshot injuries.

The limb that has been severed, should first be put in ice-cold water and cleaned. Instead of calling specialists such as neuro-, vascular, orthopedic and plastic surgeons, only one surgeon should carry out the surgery within an hour and a half so that the amputated limb does not die, he said.  Also present at the seminar was Dr Imran Shah, a revision trauma surgeon, who deals mainly with neglected and mismanaged cases of trauma at the AO Clinic in Nazimabad.

It is normal practice for people, with the complaint of pain in their joints to ignore or put off treatment. But if their condition is aggravated, there can be catastrophic consequences. He sees about four such patients a week who include those with injuries from gunshots to fractures. It may be an infection of the joints, inflammation, and dissolution of the cartilage or even osteoarthritis.

The first step is to have the blood tested to help the diagnosis. He also highlighted clinical aspects such as management with painkillers and steroids, when to carry out the surgery, which quality implants must be used, what is the best age for a knee replacement, methods of rehabilitation and what are the aftereffects of surgery.

Both surgeons pointed out that malpractice is a problem and patients are often ill advised. For instance, there is no need to carry out a bilateral total knee replacement at the same time as it can even lead to death. If both limbs need total knee replacement, there should be a gap of at least one month between then, added Dr Shah.

Published in The Express Tribune, March 26^th, 2012.