How to reattach severed fingers?

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A woman who lost six of her fingers in a work accident has had them reattached in a 17-hour operation. How best to save a severed digit?

Anne Kellow, a factory supervisor, had six of her fingers sliced off as she cleaned a packing machine.

Paramedics packed the severed digits on ice and put them in the ambulance with her on the 60-mile journey to Derriford Hospital, Plymouth. Once there, a team of surgeons worked in relays to reattach all six fingers during 17 hours of microsurgery. It is said to be the first time so many fingers have been "replanted" in one operation.

What are the key factors in successfully reattaching a severed digit?

The window of opportunity is usually six to 12 hours, and success depends on how much damage has been done to the muscles, as these are the first to die.

ANNE KELLOW'S INJURIES All four fingers on left hand cut off in straight line Also lost tips of index and little fingers on right hand Cuts not clean, but she was willing for surgeons to go ahead

To save the tissue from further damage, keep the amputated finger wrapped in clingfilm, on ice, preferably in a jar or cup with a lid. Don't put it in water as this will cause it to shrivel up and become unusable for the surgeon trying to reattach the finger. [See NHS Direct article under Internet links for more details.]

And be sure to gather up all parts of a severed digit, no matter how small. The body cannot grow a new nail bed, the tissue directly under the nail, so being able to use the original tissue makes a big difference to whether a full reconstruction can take place.

The operation to "replant" Mrs Kellow's lost digits was only possible because the industrial equipment left smooth cuts, meaning her finger tissue was in relatively good condition. Her surgeon has said that while the cuts were not as clean as he'd have liked, she was willing for the team to "give it a go".

Surgeons fixed the severed fingers in place at the bone with wires and steel plate, and then sewed the muscle tissue, small blood vessels and nerves back together. Such attention to detail improves the chances of the 62-year-old grandmother being able to regain full use of her hands, and she is now undergoing intensive physiotherapy.

David Ross, a consultant plastic and reconstructive surgeon, describes a typical "replanting" operation, in which one team starts out working on the severed body part and the other on the stump.

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"You stabilise the bones [with] either a wire or metal fixation to fuse the bones. Then you repair the blood supply to reanimate the tissue. You rejoin the arteries and veins under the microscope - it's almost like rejoining two tiny pipes together.

"The real challenge is getting the veins to work so they drain the finger. If you have poor blood drainage you can try a vein graft - if you are short of vein, for example. Or, if you have joined the veins but they aren't working together you can use leeches to salvage the finger."

Leeches - one of the oldest medical tricks in the book - act as a temporary blood pump until the finger has healed sufficiently to do this naturally. This may take up to a week.

"After working on the veins, then you do the tendons, then the nerves. Then there is the problem of repairing the skin," says Mr Ross. "The real challenge is getting a stable, functional hand. That's a lot of work for the physiotherapists."

Finger in custard

This is by no means the first case of a severed finger to make the headlines.

Last May, a US man found a severed finger in a tub of ice cream, then refused to give it back to an injured employee so it could be reattached. Instead Clarence Stowers, of North Carolina, took it home and put it in his freezer as evidence in legal action against the store. A week later he offered to return it, too late for surgeons to be able to act.

And in a case that became a popular sensation, John Wayne Bobbitt underwent reattachment surgery after his wife cut off a portion of his penis. She drove off with it and tossed it into a roadway, only for the missing portion to be recovered by police. The operation to reattach a penis is the same kind of surgery to repair a severed finger, but far less common.