8 February 2018

Kenya: KNH Doctors Re-Attach Boy's Severed Hand

Photo: Nairobi News
Joseph Theuri, 17, whose arm was chopped off by chaff cutter after a successful operation to replant severed limb at Kenyatta National Hospital.

Two weeks ago, a young man was wheeled into Kenyatta National Hospital's Accident and Emergency room writhing in pain.

When 17-year-old Joseph Theuri's right hand was severed at the wrist while cleaning a chaff cutter, there was no good reason for anyone to imagine he could be made whole again given that such accidents are commonplace among residents of Kiambu where he comes from.

As it is, many Kenyans believe that it is almost impossible to re-attach an amputated limb, and even if it can be done, it is a costly procedure that many cannot afford.

Most accidental amputations are messy affairs, resulting in crushed limbs or other serious injuries that can sometimes make such complicated procedures as re-attachment impossible.

SURGERY

However, in cases such a Joseph's, where the amputation was a clean cut, doctors say limbs can be re-implanted onto the severed part of the body.

This is what happened to Joseph on the evening of January 26, when he underwent a seven-hour procedure at KNH to re-attach his hand.

Upon receiving the patient who had been referred from Kiambu Hospital, a team of 15 plastic surgeons, orthopaedic surgeons, anaesthetists and nurses at KNH successfully carried out the procedure, which begun at 10pm and ended at 6am the following day.

The young man accidentally chopped off his arm last month while cleaning the machine used for cutting straw or hay for farm animals into small pieces.

"I only realised my hand was missing when I saw a pool of blood in the cloth I was using to clean the machine," he remembers, saying he accidentally switched on the machine when he was cleaning it.

SAFE KEEPING

While rushing him to hospital, Joseph's sister wrapped the amputated hand in a plastic bag where upon reaching the first hospital, doctors sanitised it and put it in a cooler box.

At Kiambu, the nurses worked to stop the blood flow, decrease the pain and stabilize Joseph.

The complex surgery lasted a whole night, with doctors working in two teams.

Within 12 hours of losing the hand, surgeons and specialists were working feverishly to help return the boy's body and prospects in life back to something resembling normal.

"We started the procedure immediately, working to attach the nerves, tendons and blood vessels. We also needed to align the bones," one of the lead surgeons, Dr Nang'ole Wanjala, who led the procedure with the company of the University of Nairobi's Prof Stanley Khainga overseeing the whole procedure, said.

TWO TEAMS

To save on time and ensure that the workflow was seamless, Dr Nang'ole says the team of 15 split into two, whereby one team worked on preparing the detached hand and the other team working on the stump of the forearm.

"When we received the patient what amazed us was that his hand had been preserved in cooler box. This helped keep the cells of the hand alive," Dr Nang'ole said.

According to the doctors, Joseph's prognosis shows that he will recover between 80 and 90 per cent of the functions of the hand, which also functions as his dominant limb following the operation.

"Already, we can see the blood flowing back in his hand. We determined this by pricking his thumb and seeing the blood flow," Prof Khainga said.

MILESTONE

Replantation is the surgical re-attachment of a finger, hand or arm that has been detached from the body.

Key to replantation is the time between the injury and surgery.

"We aim to have the surgery done within 24 hours of the injury but in the event that is not possible, we still give it a try. As soon as the accident happens, try and get hold of a cooler box to put the limb," Dr Nang'ole explained.

"This successful surgery adds into the list of the great milestones that KNH specialists have achieved to save, transform, reclaim and prolong lives of many Kenyans and patients from East and Central Africa," KNH's CEO Lily Koros said.

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