As It Happens

U.K. doctors save carpenter's severed hand by sewing it to his groin for 2 weeks

After more than 13 hours of emergency surgery, carpenter Anthony Lelliott left St. George's Hospital in London with his painstakingly reconstructed hand sewed to his groin.

The old-school medical technique was the only way to combat the extensive damage, says Dr. Roger Adlard

Anthony Lelliott's severed his thumb and first two fingers with an electric saw, but doctors at St. George's Hospital in South London were able to repair it after 17 hours of surgery. (St. George's Hospital)
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After more than 13 hours of emergency surgery, carpenter Anthony Lelliott left St. George's Hospital in London with his painstakingly reconstructed hand sewn to his groin.

The old-school medical procedure — called a pedicled groin flap  — helped save his hand after he cut it nearly in half with an electric saw. 

"It was possibly the only technique we could use to save his hand at this point," Dr. Roger Adlard, a consulting plastic and reconstruction surgeon who worked on Lelliott's hand, told As It Happens guest host Helen Mann.

"For two weeks, he had his hand bandaged up in this position. Pretty uncomfortable, I think you can imagine."

'A severe injury — the most complex I've seen'

Lelliott, 46, arrived at St. George's on May 30 after he sliced open his hand while cutting floorboards. He'd cut through his palm, severing his thumb and first two fingers.

"I threw myself off the saw. I don't know whether it was my brain playing tricks on me, but it was like an out-of-body experience; I could see myself and see what I'd done. There was blood spirting out everywhere," he said in a hospital press release. 

"All I remember was coming through the doors [of the hospital] and being greeted by a phenomenal amount of people; I couldn't count them."

These X-rays show Lelliott's hand before and after surgery. (St. George's Hospital)

At first, Adlard said he "wasn't too concerned" about treating the injury. After all, amputated hands are a regular occurrence at St. George's Hospital, which is a major trauma centre in the U.K.

"It became quickly evident that this was more than just a simple amputation," Adlard said. "It was a severe injury — the most complex I've seen."

Lelliott had sliced his hand with the saw not once, but twice, resulting in what doctors call a "double-level amputation." His bones were severely damaged, and his tendons, arteries and nerves destroyed. 

It took a full team of surgeons more than 13 hours to repair the damage. 

Sacrificing a finger to save the hand 

The first step, Adlard said, was getting the blood supply back to Lelliott's fingers.

"This wasn't easy because we can't just join the arteries up like we would normally do," he said. "So we harvested veins from his feet and used those to bridge the gaps between the arteries in the hand and each finger and thumb."

But the middle finger was too far gone to save.

This surgical team at St. George's Hospital saved the carpenter's hand. (St. George's Hospital)

"This was fortunate in some ways, because we also saw that there was some skin that was not surviving to the palm of his hand, and we were able to cannibalize the part from this middle finger and use it to reconstruct the dead skin," Adlard said.

"He lost a finger, but we were able to use that to save a hand."

Taking a page out of the medical history books 

But the doctors couldn't salvage enough skin from the finger to replace all that had been lost.

Usually, in a situation like this, the next step would be to perform a microsurgery technique called a "free flap" — using precision tools to transplant tissue from one part of the body to another.

But the extent of the damage meant that technique was not viable. So instead, two weeks after the emergency surgery, the doctors tried a predicted groin flap.

From left to right, Lelliott, Dr. Adlard and hand therapist Millie Chu. (St. George's Hospital)

That surgery, performed by Dr. Jamil Moledina, involved cutting a rectangular piece of skin from the patient's groin, in the area at the top of the leg, lifting up the skin flap, and using it to cover the missing skin from the hand.

Lelliott's hand was sewn in place on his groin and it stayed there for two weeks until the skin grew new roots and attached itself to his palm. Then doctors cut the hand loose. 

The procedure was common 20 or 30 years ago before more advanced microscopic techniques were developed, Adlard said. 

"It's always good sometimes to go back to history and use things that were done in the past," he said.

On the mend 

After 17 hours of surgery in total, Lelliott is recovering extremely well, Adlard said, far exceeding doctors' expectations. 

"Already, he's able to pinch and hold a pen and do fine control with his index and thumb," he said.

"His sensation is slowly returning and he's not having the horrible acute pain that he had in the first few days following surgery."

The carpenter still has a lot of physiotherapy ahead of him, but has expressed gratitude for the team that saved his hand.

"Words can't describe it because I was expecting to wake up without a hand," he said.

"It's unbelievable, really. I'm so grateful."

Written by Sheena Goodyear. Interview with Dr. Roger Adlard produced by Sarah Jackson. 

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