Punjab cop’s hand chopped off: When a severed hand can be restored, and how

In Sunday's attack on Punjab policemen who had stopped a group of Nihang sect members in Patiala over a curfew pass, the hand of an assistant sub-inspector was chopped off.

The surgery, which took 7.5 hours, was a very complex procedure. (Representational Image)

In Sunday’s attack on Punjab policemen who had stopped a group of Nihang sect members in Patiala over a curfew pass, the hand of an assistant sub-inspector was chopped off. Surgeons at Chandigarh’s Post Graduate Institute of Medical Education and Research (PGIMER) have since re-implanted the severed hand.

In which cases is re-implantation possible?

When a surgeon makes that decision, the factors that he or she considers include how much time has elapsed since the injury, the condition of the severed organ, and the nature of the injury— an organ severed with a clean cut is a better candidate than one severed by a crush type of injury.

Since the policeman’s hand had been amputated with a clean cut and the police rushed him to hospital, doctors had up to 12 hours to perform the surgery before the hand began to rot.

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The surgery, which took 7.5 hours, was a very complex procedure, “which we were able to perform because of quick action both from the police’s side and from our team of doctors. I received a call about the incident from DGP Dinkar Gupta at 7:45 am and by 10 am we had begun the surgery,” said PGIMER Director Dr Jagat Ram.

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“The patient also had lost more than a litre of blood, so we had to give him fluids and colloids to stabilise him until blood transfusion could be arranged,” said Dr Ankur Luthra, anaesthesiologist.

How is such a surgery performed?

It involves conjoining various parts of the arm and the hand — bones, muscles, tendons, arteries, veins as well as nerves. The process is called anastomosis.

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“Both radial and ulnar arteries, accompanying nerves and the dorsal vein were anastomosed successfully, allowing for the hand to receive adequate circulation,” said Dr Jagat Ram. The bones were attached using “K wires”, which will be removed once the bones conjoin organically. This takes between three and four weeks.

Can a reattached hand get its function restored?

That is the goal of doing such a surgery. The extent of restored function, however, can vary from case to case. While a successful surgery can result in good return of motor function, studies have shown that sensory recovery can often be poor.

In the policeman’s case, doctors of PGIMER have reported that the repaired left hand of the ASI is viable and warm. Whether the blood circulation is optimum, however, can only be observed within the next few days. One concern is that the hand had fallen to the ground after being severed, so doctors cannot completely rule out an infection. The patient will be kept under observation for at least the next week to ensure that he is out of danger as far as infection is concerned.

It will take at least three months for his hand to completely heal as each repaired part will take its own time to naturally conjoin. The patient will also need to attend regular physiotherapy sessions for total restoration of motor movement and sensation in his hand.

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