Page last updated at 10:20 GMT, Monday, 9 February 2009

How a limb is re-attached

Mr ASit Khandwala
Mr Khandwala carried out hours of surgery
Mr Asit Khandwala, plastic surgeon at Queen Victoria Hospital led the surgery on John Stirling, who lost his forearm in a wood-cutting accident.

Here he explains how he re-attaches a limb like Mr Stirling's arm.

We end up operating on the amputated part first.

We first take the part to theatre and clean it because it is usually quite messy.

We take the bits of wood out and X-ray it to look at the bones, sometimes they are broken at multiple levels.

Once clean we open the part and look at the blood vessels, nerves and muscles to see how bad the damage is and if it is suitable for reattachment.

Then we have to decide whether the patient is fit for procedure.

When the decision is made we go to theatre and prepare for an eight-to-12 hour operation.

'Like a jigsaw'

By the time we have the patient on the operating table we have usually prepared the limb.

When the blood vessels are more or less ready we usually flush them with fluid to clean clots.

We then put a tourniquet round the arm and start the same procedure on the side of the patient.

Obviously the bone has to have a mirror image cut compared to the opposite side so that they fit together like a jigsaw, if they don't fit he won't be able to turn his arm from side to side.

We fit the bone together first and then an artery.

We check whether the microsurgery is working and then establish flow in another artery.

Some veins are joined together so that the blood starts flowing back into the body rather than back out of the limb.

The next step is to join the nerve and then the muscle.

We take the patient back to theatre for a dressing say 24 or 48 hours later and at that stage we will use a skin graft to cover the area and gradually that closes up.



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