Daijiworld Media Network – Mangaluru (SB)

Mangaluru, Dec 15: Exceptionally rare successful surgery was performed on a 2-year- old toddler who lost both lower limb and his mother in a most tragic railway track accident in Kerala. Both legs were successfully rejoined with microvascular surgery by Dr Dinesh Kadam, Plastic Surgeon and the team at A J Hospital and Research Centre in city and now the child is able to walk without support.

The information was provided at a press meet held in city on Friday, December 15.

The boy is the youngest toddler in the world treated successfully, who sustained a complete amputation of both lower limbs, one at the proximal level, right thigh and other through the mid leg. Simultaneous amputation of both lower limbs is a rare occurrence, rejoining them is extremely rare, and so far only 13 successful cases have been reported across the world so far including 4 children. So far none reported from India.

Reported cases around the world include two each from: Belgium and Italy and; one each from -Scotland, Israel, Russia, Finland, China, Poland, Austria, South Korea and Taiwan. This is also that the youngest child, 2-year to sustain total separation of both lower limbs, is successfully operated.

Double tragic incident

On April 29, this boy was being carried by his mother. In a heart–breaking, disastrous train track accident mother lost her life, the baby survived but lost both his legs. He was lying in a pool of blood with severed both lower limbs. He was rescued by some citizens and railway police transferred to Payyanur hospital. After giving first aid, the baby was referred to AJ Hospital with limbs preserved in a box containing ice. The amputated legs were transported in a thermocol box, kept in a polythene pack with surrounding ice.

He was brought to AJ Hospital by Railway Police as unknown child. At that time the hospital had no clue about the whereabouts of this child.

It was extremely rare and critical situation for the baby and the treating doctors to take decision on further course of action. He was alert, in a state of shock, anxious looking unable to communicate, too dazed to even cry. He was very pale due to severe blood loss. The priority was to save the child,

treat the injuries. The decision on whether to do re-plantation of limbs was a big question. Rejoining was a logical step, however, was not a simple task, particularly when no parent was around. Rejoining or replanting a major limb amputation is a complex procedure, both for technical and its effects on the patient. It is a long process, involves a major alteration in the blood pressure, reperfusion injury (toxic products when pushed to circulation from re-joined limb). Such decision is taken with due considerations to all aspects, explaining the pros and cons to the family, so that they make informed decisions. It is also a major commitment to support such a decision of major surgery.

Hospital decides to proceed with consent from police

The hospital administration was dealing with extremely adorable baby, found unknown, lost his both legs and mother. They decided to give their best efforts to replant both severed limbs with a hope to succeed based on our experience in several such cases in the past. Railway police was extremely supportive of their decision, gave consent to go ahead. The surgical procedure of re-plantation is major one and involves long and multiple operations, prolonged hospital stay and intense monitoring and involves a huge cost as well. Dr Prashanth Marla, Medical director, decisively, instructed to go ahead to help whatever they could without worrying about the cost implications.

Seven- hour Microvascular Surgery

Both limbs were successfully rejoined in a 7-hour Microvascular surgery, a team led by Dr Dinesh Kadam, head of Plastic surgery. The team members include Dr Sanath Bhandary , Dr Gautham Shetty ( Plastic Surgeons), Dr Mithun Shetty(Orthopedic surgeon) and Dr Trivikrama Tantry (Anesthesiologist).

The baby had a good recovery. He was monitored intensively. He further underwent skin grafting surgeries and implant removal procedures. Bones have united and he is now able to walk independently. He has good recovery of muscle power in both limbs and good sensory recovery.

During this time of six months in the hospital, he received very warm support from everyone, particularly the nursing staff, who took charge of his daily care and feeding. He was extremely active, joyous overcoming personal tragedy of loss of mother and major injuries.

This is very tragic and sensitive incident, successful story overcoming such major loss for the baby and extremely rare achievements of plastic surgery.