Bengaluru: For 27-year-old Ganesha (name changed), a construction worker, the world came crashing down when he slipped and fell from a construction site. During the fall his right foot got entangled and severed (from ankle downwards) from the body.
For the doctors at Sparsh hospital, this was first such case. "It's very unusual to see a foot amputation. We have seen and successfully rejoined (replanted) upper limbs, fingers and toes. This is the first time we were encountering such a case in last 11 years in our hospital," says Dr Praveen Kumar HP, Consultant Plastic and Microvascular surgeon, Sparsh hospital.
The doctors had two options – replant the severed portion of the foot or carry out a below-knee amputation stump closure, followed by prosthetic treatment (adding a prosthetic foot). They opted for the former and after a marathon 10-hour surgery they were successful.
"Time was extremely crucial and the foot had to be joined before irreversible damage occurs due to lack of blood supply. So, without wasting any time, preliminary tests were done and consent was taken for surgery," Dr Kumar added. He along with another orthopedic colleague Dr Prashanth B.N. helped in fixing the bone.
"Replant is surgically difficult than adding a prosthetic or transplant. Here the surgeon has not decided the cut and the whole foot need to fit perfectly. We need to keep an eye on the arteries carrying good blood, veins carrying bad blood has to be connected,” Dr Kumar said.
He also pointed out that it was much more difficult than a finger replant, as in a finger there are no muscles and only one bone, vein and artery need to be reconnected. “Whereas in this case the blood vessels, nerves were connected using multiple vein grafts. The skin cover all around the ankle was inadequate. So in the same sitting, I covered the exposed blood vessel and nerve with free gracillis muscle flap using Microvascular technique. There was considerable blood loss preoperatively," he explained.
During the 10-hour long surgery, the hemodynamic stability was properly maintained by the hospital's anaesthesia team, led by Dr Ravi. "By the time surgery got over Ganesha’s parents had arrived at the hospital. They were not aware in what state their son had arrived at the hospital. They were able to see a foot in its normal place with a small bandage around the ankle and few metal rods holding it," said Dr Kumar.
After surgery he was moved to the ICU and gradually weaned off from all support. “He has now been discharged and soon he will be back on his foot, though the sensation may take some time to recover," Dr Kumar summed up.
