Rare Multidisciplinary Replantation

In a rare and remarkable medical feat, a multidisciplinary team of surgeons at Pride Superspeciality Hospital in Chennai has successfully reattached a completely amputated right forearm in a 35-year-old man. The extraordinary clinical success followed a gruelling surgical and reconstructive treatment journey that involved multiple high-stakes operations, resulting in early physical rehabilitation with zero infection. The treatment ensured achievement of full clinical stability with a healthy, viable limb and has been cleared for hospital discharge to continue his outpatient recovery. The patient, Mr. Dhananjayaraj, was brought to the hospital with a complete traumatic amputation of his right mid-forearm that caused extensive damage to bones, arteries, veins, tendons, muscles, nerves, and soft tissues. This life-threatening injury demanded immediate, highly coordinated surgical intervention to save his life. Understanding instantly to the critical emergency, the hospital mobilised a multidisciplinary expert team comprising Plastic and Reconstructive Surgery, Vascular Surgery, Orthopaedics, Anaesthesia, and Critical Care within minutes of his arrival. Dr. S. Chockalingam, Managing Director, along with Dr. Rajkumar, Vascular Surgeon, and Dr. Karthik Shanmugam, Orthopaedician, led the teams that would ultimately defy the odds. The primary observation by the doctors was a complete traumatic amputation with extensive neurovascular and musculoskeletal damage that posed a significant risk of the replanted limb not surviving. The first emergency replantation surgery lasted approximately nine hours. The orthopaedic team stabilised the radius and ulna using intramedullary K-wire fixation, while the plastic surgery team reconstructed multiple flexor and extensor tendons. The vascular team performed complex microvascular reconstruction using great saphenous vein grafts to restore arterial inflow and venous drainage This was a critical step that would determine whether the severed hand could be saved. However, within 24 hours, the patient developed early vascular compromise of the replanted hand. The team acted immediately, performing emergency re-exploration procedure for another nine-hour. The vascular team performed a Fogarty catheter thrombectomy and reconstructed the radial artery with additional vein grafts. Following reconstruction, both radial and ulnar arteries demonstrated pulsatile flow, with Doppler confirmation of flow into the palmar arches. The hand slowly regained warmth, colour, and capillary refill. The postoperative period required continuous vascular monitoring, anticoagulation therapy, intensive wound care, and management of infective complications. Later, the plastic surgery team performed reconstruction using a superiorly based abdominal flap, covering a 9x9 cm defect over the distal forearm. Few days back, flap division and inset completed the reconstructive journey and the patient was kept under observation. Dr. S. Chockalingam, Managing Director, Pride Superspeciality Hospital said, "This case is a testament to the power of multidisciplinary collaboration. When a patient arrives with such a catastrophic injury, every second counts, and our team&#39;s ability to mobilise swiftly made the difference between limb loss and limb salvage." After more than seven weeks of hospitalisation and multiple major procedures, the patient is conscious, oriented, haemodynamically stable, with zero infection and a healthy wound and fit for discharge with continued rehabilitation. This case underscores the importance of rapid access to specialised multidisciplinary care in traumatic amputation injuries, where every minute counts.