CHENNAI: Over a year ago Dasarathi Jawahar, a 29-year-old IT professional was on his way to his office, when an earthmover moving backwards, pushed him off his bike. He was partially run over by the mover and suffered serious injuries to his right foot. Faced with the risk of amputation of the injured foot, a foot reconstruction surgery performed by the doctors at Gleneagles Global Health City, Chennai has given him a new lease of life.
The doctors at Gleneagles recall that Jawahar was rushed to the emergency room in a state of shock due to massive blood loss. On further inspection, the doctors found that Jawahar had sustained a large wound on the medial and anterior aspect of the foot and lower leg measuring approximately 35* 12cm. His foot was also found to be severely contaminated with grease and mud, with exposed unstable foot bones. The blood vessels to the toes were also left severely damaged due to the impact of the accident.
A team of surgeons headed by Dr Selva Seetharaman alongside Dr Kesavan, Dr A P Siva Kumar and Dr Siva Reddy came on board and decided to perform foot reconstructive surgery by using microvascular techniques. What followed was an extensive wound cleaning procedure. This was followed by microscopic reconstruction of the blood vessels, enabling blood supply to the toes. The foot was then stabilized with K- wires and external fixators. The wound cleaning procedure was continued until the entire contamination and dead tissues were removed.
Following the wound treatment, a wound closure procedure was done by using flap (tissue with blood supply) from the opposite thigh by microvascular free tissue transfer. The tissue (flap) from the thigh was harvested with its blood supply and used to cover the wound in the foot. The blood vessels in the flap were joined to the vessels in the foot by microvascular surgery using suture materials thinner than the hair. This was achieved by using a 10 x magnification microscope. The entire microvascular procedure took around 8 hours to complete.
Dr Selva Seetharaman, Head of the Department, Institute of Plastic Aesthetic and Cosmetic surgery, Gleneagles Global Health City says “We considered an option of amputation (removal of foot) taking into account the nature of injury and status of infection during course of the treatment to save his life and avoid any further complications but we continued with cleaning procedures and appropriate antibiotics which cleared the infection and the foot was finally out of danger.” Dr Seetharam says that adopting immediate cleaning procedure (Debridement) and the microvascular free tissue transfer contributed to the success of the surgery.
“Stability of the bones is necessary to provide a strong base for the injured tissues to heal and for return of walking function, eventually. In this patient, there was a loss of some bones in the ankle and foot. Stability was achieved with External rods and pins inserted into the bones, which were removed after the tissues healed”, added Dr Kesavan, Senior Consultant Orthopaedics Gleneagles Global Health City.
The doctors say that the exemplary mental determination of the patient also played a crucial role in the success of the surgery.
Following prolonged physiotherapy sessions and a walking practice using support boots, the patient has now resumed his day-to-day activities.
