The surgeon warns: we have a “harvest” of crushed fingers, torn shoulders, severed arms and hands

Proven content

– We have two seasons of the “harvest” of cut fingers and hands. The first is winter, when people use axes or circular saws to cut firewood to heat homes. And the second is summer and autumn, when farmers crush or tear off their hands and shoulders while working in the field because they carelessly use agricultural machinery – says Dr. Ahmed Elsaftawy, an eminent specialist in hand surgery.

1. Dr. Ahmed Elsaftawy: If I see “luncheon” after putting my hand into an electric meat grinder, there is no chance of recreating the gripping function or sewing it on
2. The surgeon tells you how to help when we witness an accident
3. He also talks about the most difficult cases he has encountered in his career
4. – In 2018, a 9-year-old was attacked by a dog. The boy’s left arm was practically scalped of skin and muscle, only the bone remained. Gratjan has undergone many procedures, including sewing a damaged limb into his abdomen. Today, with this hand, she easily ties her shoes – says Dr. Elsaftawy
5. You can find more such stories on the TvoiLokony home page

Edyta Brzozowska: Have you ever counted how many torn or torn squares and hands you sewed back onto the bodies of accident victims?

Dr. Ahmed Elsaftawy, Lower Silesian Center for Hand Surgery and Aesthetic Medicine «Chiroplastica»: Not. I remember these failed operations more. Cases are varied, for example, I operated on a man whose hand had hot papa and he came to me like a Terminator, his fingers without a trace of skin on his bones. Fortunately, I was able to recreate his grasping function, although accepting the appearance of the hand is still difficult for him.

To this day, I am in contact with a paramedic, volunteer firefighter and a farmer in one person, who put his hand in a hay packing machine during the harvest season. He had a multi-level limb amputation injury. I sewed his hand on, but on the tenth day I had to amputate it because gangrene started. Now he wears a prosthesis that is more cosmetic than functional, but he hasn’t lost his spirits.

We have a harvest season, will similar accidents happen more often?

Unfortunately, as every year. This is harvest, and in its literal sense: harvest as agricultural season and portable season, including for surgeons. Here comes the plague of hands, fingers, shoulders, arms and forearms, and whole hands torn off by agricultural machinery. The surgeons will have a lot of work to do until late fall. And then the second season of the surgical harvest will begin.

Is it about winter, the time of heating houses with firewood?

Exactly. This heating season is associated with the use of axes and circular saws. But we surgeons call it “clean”, because suturing on a limb or a part of it that has been evenly cut with a sharp instrument is much easier, and thus the restoration of vital functions is much faster.

Are lacerations and crushing wounds more difficult for a surgeon caused by the operation of large agricultural machinery?

This is how it really looks like, and the accident is easier when people drink alcohol while working in the field. And there are many types of machines that replace a person with manual performance of various activities. There are mowers, hay rakes, loaders. For example, such a hay baler also has the function of compacting and dicing the hay. A moment of inattention is enough for her to grind our hand, and such a trauma is multi-level.

What does it mean: multi-level?

That we have damaged tendons, scarred bones. The main drawback of such injuries is damaged nerves, and in adults, peripheral nerve surgery is difficult. And while we are dealing with the amputation of one or two fingers, in which there is no total sensation, it does not have to be very troublesome for the patient: he still has some grasping function of the hand and it is better or worse, but somehow copes with everyday manual activities .

And when the nerve damage is extensive?

Treatment of such an injury is difficult to test, and it is almost impossible to return to the state before the accident. And if we are dealing with a median nerve injury, it means a disturbance in the sensation of three and a half fingers. These are difficult cases, especially if the agricultural machinery destroys a large proportion of the patient’s muscle mass. Muscles are very sensitive to ischemia, hypoxia and crushing. And even if sometimes it is possible to restore the blood circulation in the limb, during the healing – if symptoms of muscle necrosis occur – even though the hand is alive, we are forced to amputate it.

Muscle necrosis is life-threatening?

Remember that agricultural machinery is often contaminated by various anaerobic bacteria and if the area of ​​the ischemic muscle is large, practically the entire limb is deprived of its functions. And the presence of such a limb is an enormous burden for the patient’s organism, including a threat to life.

Hand surgery is a very difficult field of medicine? After all, it must combine knowledge of orthopedics, vascular surgery, plastic medicine and several other medical specialties.

Yes, hand surgery is a demanding specialization. But when it comes to supplying the blood supply necessary for the limb – contrary to appearances – it is technically not difficult to do. A satisfactory effect can often be obtained by fusing one vessel, so, paradoxically, reconstructing an artery is probably the easiest procedure in the entire operation. Other things are the most demanding, such as stitching the veins, especially in people aged 45+. In people of this age, the walls of the veins are very delicate and fragile. And if we are dealing with a laceration injury, sometimes we search for this vein by force. And it often happens that we do not find the right one. Then we do a bypass, which means that we take part of a healthy vein to restore the continuity of the venous anastomosis.

The treatment of such serious injuries is certainly not limited to one operation.

Of course. For example, in a pulling trauma, when the finger nerve is in a bad condition, we break down the treatment into stages: first we take care of the healing of the finger so that it survives. And we deal with the surgery of the finger nerve at a later time, after it has completely healed. The case is different with the main nerve, because it innervates several fingers. If the defect is large, the matter becomes even more complicated and often requires the establishment of a type of bypass, and the quality of this nerve will not be the same as before the accident. It depends on the length of the graft: the longer it is, the worse the results.

What is the most important for you as a surgeon when an accident patient is brought to the operating table?

That the hand would survive. The rebuilding of the grasping function or the restoration of feeling are, of course, equally important. But that can be dealt with later. Anyway, every accident patient will be for years, or even for the rest of his life, a person with a disability and a frequent visitor to hospitals. For example, due to the need for control, reconstruction treatments, rehabilitation, and restoration of grasping functions.

How is this function reproduced?

In two stages. First, we create a silicone prosthesis, which is a kind of sheath for the future tendon, and the patient walks with this prosthesis for about three months. After this time, we transplant his tendon from the forearm or the extensor of the toes and we need several weeks for further rehabilitation. In total, such a patient is associated with the hospital and the surgeon for at least two years. But I am talking about successful cases of this kind of surgery.

What if they fail?

Fortunately, there are proportionally more cases with an optimistic finale than unsuccessful ones. Sometimes, however, the patient is disqualified for surgery at the very beginning. This is due, inter alia, to the so-called «Implantation service». This is one such emergency room for hand surgery, with one surgeon for the whole country. There are several centers on this website that are on duty in shifts. In the event of an accident, the hand surgeon asks the SOR physician to provide photographic documentation of the injury and x-rays. On this basis, the patient can be qualified for transport to hand surgery and surgery. Or refuse.

What can disqualify a patient?

If I see a literal “luncheon” after putting my hand into an electric meat grinder, there is no chance of recreating the gripping function or sewing it on. So only the decision is made about medical supplies. I believe that there are far too few such “implantation service” centers and the surgeons on duty there, and their organization leaves a lot to be desired. For example, Poland could be divided into several areas and set up several specialized sites for this type of emergency.

How to behave when we are witnesses or victims of such an accident?

I believe that everyone should become familiar with the procedure and how to behave in such cases. After all, such an accident can happen anywhere and to anyone.

First and foremost, the injury must be secured, otherwise there will be bleeding out. Then turn off the mower, saw or other electric machine while it is running. This means that only a safe lifeguard will be able to help. He must also keep a cool head, because the accident victim may behave irrationally in shock.

What about cut body parts?

The cut part of the finger, hand and other solid parts should be put in the bag, and this bag in another bag filled with water or with the addition of ice. The idea is to cool solid parts of the body during transport. But under no circumstances should they come into direct contact with the ice! Otherwise, they will be unfrozen, and then they will be useless.

Do you remember your first hand replantation operation in your life?

Of course. He was a 17-year-old boy from Zakopane who cut off four fingers on a wood saw as he prepared for the heating season. The whole operation seemed to be a success. The only complication was necrosis of the distal phalanx of the index finger. After all, instead of missing four fingers, he has three and a half. As I said before, I am more tormented by unsuccessful surgeries, when, after seemingly successful surgical actions, I have to amputate in the following days.

Is it a great trauma for such a patient?

Yes, because he had already seen his living hand, he was enjoying it. The trauma is then more painful, because it is double. I also had a patient who helped my husband cut a tree and lost three fingers. I sewed them all on, but only one eventually caught on. And it is the one who turned pink and warmed the latest, that had the least prognosis. Then she told me about her breakdown: «I have seen my hand as it was before the accident. And then, finger by finger, I hoped to lose them and there was how much was left ”. It is a very unpleasant memory for me.

You also participated in the famous operation on Gratian’s hand.

In 2018, a 9-year-old was attacked by a dog that bit him so much that practically only a bone was left of the boy’s left hand. The limb was literally scalped, but luckily the animal spared some tendons and nerves on the palm side. The hand was alive.

To save her, together with the team we cleaned the wounds of dirt and dead tissue, and then sewed the arm under the skin of the abdomen. I created a peculiar pocket, one inside out, where on one side was sticking out the elbow and on the other hand. It lasted for four weeks and after this time the abdominal lobe grew into the defects of the hand. It all ended well, also because the wound healing abilities of children are phenomenal. With time, I also performed a full tummy tuck, including moving the navel to the right place. All this so that he would not have complexes in the future and would not be ashamed to undress.

How does Gracjan function today?

He underwent a lot of treatments and rehabilitation. Visually, it is no different from its peers. And when I asked him quite recently if there was any manual activity that was difficult for him, he replied that there was no such manual activity. He also sent me a video showing how with this hand he ties his sports shoes without any problems. I am very proud of him.

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