How to successfully reattach severed limbs

Sew on and restore severed limbs

Today many things are possible in hand surgery that hardly anyone would have thought possible in 1969. Some dangers are still underestimated today. A chief doctor about cat bites, the correct packaging of severed limbs and artificial tissue.

"In hand surgery, minor injuries are also very special."

Today many things are possible in hand surgery that hardly anyone would have thought possible in 1969. Some dangers are still underestimated today. A chief doctor about cat bites, the correct packaging of severed limbs and artificial tissue.

The patient easily reaches for a glass of water, passes it from the left to the right hand and back. "A sensational result," comments his doctor. What would be nothing special for other people is a miracle for the 73-year-old: In 2013 the farmer had both arms caught in a band saw while doing carpentry work. The right forearm was completely severed, the left was just hanging on. Now he is for another follow-up examination at the BGU accident clinic in Frankfurt.

The clinic is about to celebrate a milestone: on August 18, 1969, 50 years ago, the hand surgery department was founded - one of the first in Germany. Today it is head physician Michael Sauerbier.

Hand surgeons keep making it into the media with spectacular operations. In Munich, a 13-year-old who had had a bathing accident was recently sewn on a torn forearm in a nearly ten-hour operation. In the 1990s, Sauerbier's predecessor removed three toes from a five-year-old who had lost all of his fingers and used them to model replacement fingers.

Of course, not all cases are so spectacular. But: "In hand surgery, minor injuries are also very special," says Sauerbier. Anyone who only slips with a knife while chopping tomatoes often severes two tendons, two nerves, two vessels and, with a bit of bad luck, even the bones. Hands are not only extremely important for us humans, they are also particularly at risk.

Microsurgery was a crucial step in plastic surgery

According to statistics from the employers' liability insurance association, 40 percent of all occupational accidents are hand injuries. In addition to accidents at work, gardening tools, carpet cutters and motorcycling are also risk factors. Cuts, breaks or bruises are among the most common types of damage. An underestimated danger is animal bites in the hand, says Sauerbier. After a cat bite, such wounds should be viewed in the hospital immediately.

"Microsurgery was the decisive step that plastic surgery is where it is today," says Sauerbier. You can completely transplant skin, muscles and nerves "in a nourishing vessel" from one place in the body to another. Frequently, pieces of tissue are removed from the back or thigh. In contrast to, for example, a breast reconstruction after a tumor, it is "always very laborious to restore a hand".

In cases that end well, such as the farmer's accident, limbs are neatly separated and can be sewn back on. Of course, this is by no means easy. Every tiny nerve, every millimeter-thin vein must be connected. "That requires considerable perfection," says Sauerbier. If the tissue has to be removed from another part of the body, eight to ten colleagues are on duty. One team is responsible for the extraction region, one for the recipient region. According to the chief physician, whether it works is primarily due to one factor: "experience".

A lot of potential for the future of trauma surgery

The methods of sewing hands back on or of reconstructing them have become finer, says Sauerbier, and the technical aids such as microscopes are better. "New procedures are increasingly available to us for the treatment of the hand," said Andreas Eisenschenk, President of the Society for Hand Surgery (DGH), in June at the world's largest international congress for hand surgery and hand therapy in Berlin. Before the operation, for example, 3D models made it easier to plan an operation precisely.

On the other hand, the time within which a severed body part can be preserved has not become longer. The so-called ischemia time is around six hours for one arm and around ten hours for a finger - if it is "well positioned," says Sauerbier. Chilled, but not directly in the ice, advises the expert, in a sterile container that is cooled with ice.

"I've been lucky 100 times," says the farmer six years after his accident. His son found the unconscious father, the tenant became the first aider, the victim plus the expertly wrapped arm were flown to Frankfurt, and in a ten-hour operation, the severed right arm and the half-torn left arm were sewn back on. "Without you I would have lost my arm", the 73-year-old says to Sauerbier today, "if not my life".

And the development continues. It is no longer an isolated case for people who have lost a hand to have a dead hand transplanted. Such an intervention has not yet been carried out at the BGU. Another research approach that could revolutionize hand surgery in the future is the cultivation of replacement tissue. Sauerbier has great hopes for this development, even if he says today: "We haven't got that far yet."

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