On Sunday September 3, a 20-year-old man was brought to the Peradeniya Teaching Hospital with his severed hand in a plastic bag filled with ice. In a four hour operation, the first of its kind in Kandy, surgeons successfully reattached the hand. Full circulation was restored immediately and the young man can now flex a finger.

The man’s hand was slashed off by a sword, in a fight at 9.00 am on Sunday September 3. He had been taken to Matale hospital and immediately rushed to Peradeniya, with the amputated wrapped in a plastic bag with ice. He arrived at Peradeniya at 12 noon

At Peradeniya, Dr. Anthony, senior surgical registrar, saw him. The specialists on-call were quickly contacted. Dr. Esufali, general surgeon took the patient to the operating theatre where he was anaesthetised by Dr. Alahakoon. Dr. Suraweera, on call orthopaedic surgeon was called to the theatre.

The operation to re-implant the wrist began at 12.30 p.m., 3 1/2 hours after the injury. Dr. Anthony prepared the wrist by cleaning it and finding the arteries. Dr. Esufali re-implanted the wrist by joining the 2 arteries at the wrist. The radial and ulnar arteries measuring 3 mm were joined with fine 6/0 prolene using a continuous suture. This took 1 hour. At the end the arteries were pulsating satisfactorily. Next the median nerve was joined with fine prolene sutures in an interrupted method joining the nerve sheath. The tendons were then joined in a standard way.

Dr. Suraweera used a power drill to insert 2 pins through the back of the wrist to stabilise the bones joining the bones that had been cut. 3 pins were used. The arteries and the nerve and the tendon joints were held firmly so that they would not be disturbed during the drilling.

After bony stabilization. 2 veins at the back of the wrist were joined again using fine prolene 6/0 sutures, in an interrupted method.

The skin was then closed with loose skin sutures. The whole procedure took over 4 hours. At the end the Oxygen saturation monitor on the thumb registered 95% and the surgeons were confident of a viable re-implant. Heparin was used to thin the blood flow to the hand.

Dr. Rohana and Dr. Pathmanathan assisted and there was assistance from the medical students.

The hand has remained well vascularised with minimal swelling. The wounds are healing well, with little signs of infection. He has started physiotherapy to keep the joints of the fingers supple. The nerve will take 3-6 months to recover. The long tendons are supplied above the wrist, so there are some finger movements already.

Experiences from other centres abroad show that wrist and upper limb re-implantations are successful and patients are overall very satisfied with the result when the limb survives. Lower limb survival and later function are generally poor and patients sometimes opt for amputation, because the prosthetic lower limbs for mobility are better and less painful.

Surgeons at the Peradeniya Teaching Hospital are confident of a good result in their patient with time and good physiotherapy. The early transfer, clean cut, early re-implantation and good team effort have helped to make this operation a success.