Introduction
Accidents can change lives in an instant, demanding quick and precise medical intervention to save lives and limbs. One such story is of Sameer Ghadodra, a 46-year-old male whose resilience and timely surgical expertise turned a devastating accident into a tale of recovery and hope. This case study highlights how Dr. Leena Jain’s skill in reconstructive microsurgery and hand surgery played a pivotal role in saving Sameer’s right upper limb. With over 7 years of expertise, Dr. Leena Jain is a highly renowned Plastic Surgeon in Mumbai.
Patient Background
Sameer was traveling on a Mumbai local train when tragedy struck. A sudden accident resulted in the amputation of his left arm at the elbow and a dislocation of his right elbow. While his left arm required urgent wound care, his right arm seemed externally intact, concealed under a plaster slab. However, the hidden threat of compromised blood flow demanded immediate attention.
Diagnosis:
Right pink pulseless upper limb with closed fracture dislocation. This life-threatening vascular emergency required immediate surgical intervention to prevent irreversible damage to the limb.
Symptoms:
Upon Sameer’s arrival, he exhibited the following:
Plaster Slab on Right Elbow: Covering a closed dislocation with no visible injuries.
Amputated Left Arm: Dressed and managed.
Pulse Deficit: The absence of a detectable pulse in his right wrist.
Low Oxygen Saturation: Recorded at just 40-50% in the fingers of his right hand.
These findings raised serious concerns about the viability of his right arm despite the absence of external injuries.
Diagnostic Method
Routine evaluations often reveal critical, underlying issues. Dr. Leena Jain conducted a meticulous head-to-toe examination and identified the alarming symptoms. Here’s how the diagnosis unfolded:
Physical Examination:
- Observed plaster over the right elbow with no pulse in the wrist.
- Detected oxygen saturation anomalies in the digits of the right hand.
CT Angiography:
- Confirmed a thrombus in the brachial artery of the right arm.
- Highlighted an arterial blockage compromising the blood supply to the upper limb.
Treatment Procedure
Timely and meticulous planning led to a successful outcome. The procedure involved several critical steps:
Pre-operative Preparation
Patient Stabilization and Thorough Assessment: Sameer’s overall health was stabilized, ensuring he was fit for surgery. Vital parameters, including blood pressure, heart rate, and oxygen levels, were closely monitored to rule out any systemic complications from the trauma.
Detailed Procedure Explanation: Dr. Leena Jain personally explained the surgical steps, potential risks, and expected outcomes to Sameer and his family, ensuring they felt reassured and informed throughout the process.
Pre-surgical Imaging and Mapping: A detailed CT angiography was performed, providing a comprehensive view of the vascular blockages and enabling precise surgical planning. This step was crucial in identifying the exact length and location of the thrombus.
Step-by-Step Procedure
Exploration:
An incision was carefully made in the upper arm to expose the affected brachial artery. Extreme caution was taken to avoid damage to surrounding nerves, muscles, and tissues. The surgical team ensured a sterile field to minimize infection risks.
Thrombus Removal:
The identified thrombus, measuring approximately 8 cm, was meticulously removed. The damaged arterial segment was excised to prevent recurrence. The team used advanced microsurgical tools to ensure precision and protect the integrity of adjacent vascular structures.
Brachial Artery Reconstruction:
A segment of the patient’s saphenous vein, harvested from the leg, was prepared for grafting. This vein graft was delicately sutured to the ends of the excised artery, recreating a continuous pathway for blood flow. Ensuring seamless connections at both ends of the graft was critical for restoring circulation.
Monitoring and Closure:
To confirm the reconstruction’s success, the team monitored the restored blood flow by palpating the radial pulse and checking oxygen saturation in the hand and fingers. The surgical incision was closed with precision sutures, promoting optimal healing and minimizing scarring.
Post-Surgery Guidelines
Recovery required diligent monitoring and adherence to aftercare protocols:
ICU Monitoring:
The patient was monitored in the ICU for 4-5 days post-surgery. The surgical team conducted frequent checks of the radial pulse and oxygen saturation levels in the right hand and fingers to ensure sustained blood flow and prevent complications such as re-thrombosis.
Medication:
A carefully curated regimen of blood thinners was prescribed to prevent clot formation. Pain management was tailored to Sameer’s needs, ensuring his comfort while avoiding overuse of medication. Antibiotics were also administered to ward off infections.
Suture Removal:
Two weeks after surgery, sutures were removed under sterile conditions. The surgical site was examined for signs of infection or delayed healing, and the patient was advised on wound care to promote recovery.
External Fixator Care:
The external fixator applied to stabilize the elbow and prevent further dislocation was scheduled for removal after six weeks. During this period, the patient received guidance on maintaining hygiene around the fixator to avoid infections. Once the fixator was removed, a structured physiotherapy program was initiated to regain strength and mobility in the arm and fingers.
Outcome
Sameer’s recovery marked a medical triumph:
Survival of the Right Limb: Full restoration of blood supply saved his right arm and fingers.
Successful Skin Grafting: His left elbow stump was covered with healthy skin, aiding in faster healing.
Emotional Relief: Sameer regained hope, knowing his functional independence was preserved.
Long-term Expectations
With continued care and rehabilitation, Sameer’s prognosis is optimistic:
- Regain complete range of motion in the elbow and fingers.
- Resume daily activities with enhanced independence and confidence.
- Improved quality of life with physiotherapy and regular follow-ups.
Patient Feedback
Sameer Ghadodra:
“Dr. Leena, words cannot fully express my gratitude for your extraordinary care and skill. You saved my only functional upper limb, giving me the chance to regain independence and perform simple tasks like eating with my own hands. Your timely intervention and compassion brought hope to me and my family during a very dark time. I am forever grateful for your dedication, expertise, and the personal attention you showed throughout my recovery journey. Thank you for everything!”