Apollo Hospitals Hyderabad Pioneers Hand Replantation, Bringing New Hope to Trauma Patients

Apollo Hospitals Hyderabad proudly announces the successful completion of a complex microvascular replantation surgery, marking the first time such a major proximal limb reattachment has been performed in the two Telugu states. This breakthrough surgery exemplifies Apollo’s leadership in advanced trauma care and brings renewed hope to patients with severe limb injuries.

On October 11, 2024, a 32-year-old patient, Mr. A. Pavan Kumar from Mancherial, arrived at Apollo Hospitals Hyderabad after suffering a severe elbow-level amputation of the right hand, along with a complex broken and shattered Grade 3c open fracture of proximal humerus, the long bone in the upper arm connecting to the shoulder joint, along with the multiple fractures in the amputated part. The muscle damage was also extensive in both the portions, making the surgery even more complicated. Despite surpassing the critical “Golden Hour” window of 4 to 6 hours for reimplantation, Apollo’s expert team acted swiftly, bypassing the ER process and transferring the patient directly to the operating theatre for immediate intervention.

A dedicated team of surgeons, led by Dr. G N Bandari, Consultant Hand, Wrist, and Microsurgeon, and supported by Dr. Guru Prasad, Plastic Surgeon, Dr Vivek Reddy, Orthopaedic surgeon, ⁠Dr Sharanya, Anaesthetist, ⁠Dr Raj Kumar and Critical Care Specialist, carried out the intricate eight-hour surgery performed by two teams, simultaneous. While one team meticulously prepared the amputated hand, while the other worked on Mr. Kumar’s arm to enable reattachment. With the assistance of junior hand team doctors Dr. Syed Noaman Quadri and Dr. Ganesh Perke, nurses Dariya and Payal, technician Naveen, and the critical care team, the surgery was a remarkable success.

Today, 26 days post-surgery, Mr. Kumar is on a promising recovery trajectory. His reattached hand is healing well, with plans for additional surgeries in six months to further restore finger movement and sensation.

Dr G N Bandari, Consultant Hand, Wrist, and Reconstructive Microsurgeon at Apollo Hospitals Hyderabad, said, “This surgery is a milestone in microvascular reimplantation, demonstrating what is possible even beyond the traditional golden hour of replantation. We hope to inspire greater awareness on how immediate care and transport of amputated parts can be critical for successful reimplantation. The Golden hour will be limited to 4 to 6 hours for replanting of the upper portions of the hand, while the lower part of the limb, be it wrist, fingers, the golden hour can be up to 6 to 8 hours. It is very important to create awareness among the public that such amputated limbs can be replanted and need to reach a hospital which can treat such patients, as soon as possible. Often patients involved in such accidents of limb amputation reach the nearest hospital, who often overlook the possibility of Replantation as they lack such expertise. Also patients and their attendants lack knowledge about how to handle such amputations. When a limb gets amputated, the amputated part has to be first washed in water and preserved in a polythene cover or aluminium wrapper and such cover with the limb has to be placed in an ice pack. Some patients place the amputated limb directly in ice, which leads to frost bite injury and the limb tissue becomes dead and can’t be used for replantation. Also patients with limbs lost in the past or due to defective births, can get hand transplantation through a latest technique by sourcing cadaver hands, it has not been done in the Telugu states yet, but we are working towards such hand transplants in the near future. The cadaver hands donation can be facilitated through Jeevandan, we have proposed to the government for such permission.”

Mr Tejesvi Rao, CEO of Apollo Hospitals, Telangana Region, added, “This achievement is a testament to Apollo’s unwavering commitment to cutting-edge medical solutions. Our teams are dedicated to providing transformative care, redefining the standards of trauma treatment. We are proud to offer such world-class medical breakthroughs to our communities across Telangana and Andhra Pradesh.”

Dr Ravinder Babu, Director of Medical Services at Apollo Hospitals Hyderabad, highlighted the significance of this milestone, stating, “Our success in this complex replantation surgery is a result of Apollo’s dedication to building highly specialized teams equipped with advanced skills in microvascular procedures. This accomplishment reinforces our commitment to patient-centred excellence and showcases the potential for life-changing recoveries even in the most challenging cases. In such injuries involving amputation, the most critical thing is the hospital we go to and how quickly we go there, these two factors determine the outcome of the surgery. There is tremendous advancements in hand surgery and such procedures can be done competently, thereby restoring the hand and its function.”

Patient Pavan said, on amputation of my hand in Mancherial, my hand was securely packed and sent along with me to Apollo Hospitals, Jubilee Hills. I was not optimistic of getting back my hand, but today my hand is recovering, I am thankful to Dr Bandari and Apollo Hospitals. My message to public is not to get panicked in instances of limb amputation, try and reach the hospital as soon as possible with properly preserved limb.

Path Forward by Apollo Hospitals, Hyderabad

This case serves as a landmark advancement in trauma care in the region, notable for its unprecedented success in reattaching a proximal limb beyond the golden hour. It also underscores the critical need for public awareness on the preservation and prompt transportation of amputated body parts within the stipulated timeframe, which can significantly enhance reimplantation success rates.

Moreover, this case sheds light on future directions in hand transplantation, where donor hands, harvested from brain-dead or live donors, may provide eligible recipients with transformative surgical solutions that restore functionality and prevent lifelong disability.

Apollo Hospitals Hyderabad remains at the forefront of medical innovation, constantly striving to improve outcomes and extend the possibilities of trauma care, hand reimplantation, and transplantation for the benefit of patients across the region.