A 70-year-old farmer whose fingers were amputated in an accident on January 26 was discharged from hospital recently after all his fingers were reattached in an 11-hour-long operation. Advertising The farmer accidentally injured all his fingers while working on his farm in Baramati so badly that only one of his little fingers remained hanging by thin skin. After receiving first aid at a private hospital, he was admitted to Inamdar Hospital in Fatimanagar hours after the injury at 5 pm. His amputated parts were immediately preserved in cold storage. Dr Sumit Saxena, plastic and cosmetic surgeon at Inamdar Hospital, said the replant procedure was started at once. After the 11-hour operation, he was kept under observation for a week, after which he had regained movement in his fingers. He was then discharged. Multiple fingers reimplant is a tricky and difficult operation, but with the advancement of micro-surgery, it is possible to replant a totally amputated finger by restoring blood supply and repairing tendons, nerves and bones, a statement by the hospital said. Saxena said the patient was advised on the need for regular follow-ups to assess the vascularity, bony union, range of motion and nerve recovery. Further procedures that may be required for the tendons include tenolysis/transfers, neurolysis for the nerves and prolonged physiotherapy, he added. Doctors said the success of the operation depends on the nature of the injury, warm ischemic time (the duration of time between amputation and replantation), age of the patient, smoking habit, preexisting diseases like diabetes, site of injury and contamination. What doctors say According to doctors, basic first-aid should be given immediately. The injured hand should be wrapped in a clean dressing and elevated with direct pressure applied to limit bleeding. Attempts to ligate arterial bleeding should be avoided, as this could result in more injury to blood vessels. The amputated part should be retrieved, even if it appears unlikely that replantation is possible. Ideal warm ischemic time is six hours. But it can be lengthened to 12 hours by wrapping the amputated part in a saline-moistened gauze sponge placed in a plastic bag. The plastic bag should be sealed and placed in a container of ice. The amputated part should never be placed directly on ice because this could result in frostbite injury to the vessels. The part should also never be immersed in water, which makes digital vessel repair more difficult and less reliable. When considering multiple-finger replantation, the finger with the best chance for successful replantation, best expected recovery, and most significant contribution to function, should be repaired first. If all the fingers are injured equally and have the same chance for successful repair, the order of repair should first be the middle finger, then index, then ring, and lastly the little finger. Advertising The replanted part never regains 100 per cent of its original use and most doctors consider 60 per cent to 80 per cent of use an excellent result.

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