Golden hour management restores partially blind person’s hand 

Timely treatment and golden hour management at a private hospital in the city saved the hand of a 37-year-old partially blind person after a nine-hour surgery.

The male patient, who was brought to HOSMAT Hospital’s emergency department with a history of a workplace injury, had suffered a traumatic amputation at the mid-hand (metacarpal) level.

Hospital Medical Director Ajith Benedict Rayan said the person sustained an injury to his left hand while working with an aluminium cutting machine in a central government firm on February 10 at 2 p.m. “The amputated hand was properly packed by local doctors and was shifted to our hospital by 4 p.m. accompanied by a nurse. On examination, the left hand showed a traumatic amputation at the mid-hand (metacarpal) level, with exposure of bone, tendons and soft tissue, which was contaminated with aluminium dust and particles,” the doctor said.

A team led by Deepu N.K. and Vithal M. – Plastic and Microvascular Surgeons –  and Salma Sultana, an Anesthetist, conducted the surgery over a period of nine hours.

“The team started cleaning the part at 4:30 p.m. and it took nearly one and a half hours to get rid of aluminium debris on the amputated part and prepare for the surgery. A thorough wash was given and the patient was immediately taken to the emergency operating theatre for a left-hand replantation surgery under brachial plexus block (BPB),” the doctor said.

The surgery was done and four fractured bones were fixed. As many as 12 tendons, five nerves, four arteries and four veins were reconstructed to restore hand viability. On the fourth day after the surgery, the patient is doing fine and the hand is maintaining its blood supply. While the patient will be discharged in two days, he will have a prolonged rehabilitation period to regain his hand function.

Dr. Rayan said it is a classic case of golden hour management and proper transport of amputated hand by the Primary Health Centre (PHC). “Most importantly, the operating team concluded the operation within the stipulated time to ensure restoration of blood supply within 12 hours,” the doctor added.