Four Years of Perseverance, A Miracle of Restoration | SHHMU Saves Patient’s Severely Severed Left Leg, Helping Him Return to a Walking Life

Lead:

       Four and a half years, seven hospitalizations, 12 surgeries – a "battle to save the limb" spanning over 1,600 days recently concluded successfully. The Hand and Foot Microsurgery team at the Second Affiliated Hospital of HaiNan Medical University(“SHHMU”), relying on their exquisite surgical skills and persistent efforts, ultimately succeeded in preserving the limb of a patient with a severe severance injury, achieving a medical miracle.

In February 2021, motorcycle enthusiast Xiao Pan experienced a life-altering accident: on the Nandu River Bridge, his motorcycle skidded at a speed of 60 km/h, and Xiao Pan fell from the 12-meter-high bridge. His left lower leg was almost completely severed, connected by only 1-2 cm of skin. There was extensive segmental destruction of bone and muscle tissue in the mid-calf, multiple fractures throughout the body, vascular rupture, hemorrhagic shock... his life hung in the balance.

After being rushed to SHHMU, the medical team faced a difficult choice. According to conventional practice, amputation would have been the safest option to save his life. However, confronted with this young life and his strong desire to keep his limb, Hu Chaobo, Director of the Hand and Foot Microsurgery Department, led his team in resolutely taking on the challenge.

After urgent discussion, the medical team formulated a treatment plan rarely seen in China: "ectopic banking and subsequent replantation of the severed limb." This plan was divided into two stages: first, the severed left lower leg would be debrided and temporarily "banked" onto the right lower leg using precise vascular anastomosis techniques; after the condition of the left leg stump improved, it would be replanted back to its original position. This approach both reduced the patient's immediate life-threatening risks and created the possibility of saving the limb.

On the night of the surgery, the medical team divided into three groups working simultaneously. The first group handled systemic wounds and controlled bleeding; the second group cleaned the left leg stump, preparing conditions for subsequent replantation; the third group was responsible for "grafting" the severed left lower leg onto the right calf. After working through the night, the severed limb successfully found a "new home" on the right leg, and Xiao Pan's vital signs gradually stabilized post-treatment.

In preparation for the critical replantation surgery stage, to ensure its success, Director Hu Chaobo specifically invited world-renowned microsurgical reconstruction expert Professor Wang Zengtao and Director Hao Liwen from Shandong Provincial Hospital for remote consultation and surgical plan guidance. The participation of these top domestic experts provided crucial theoretical support and technical assurance, further refining every detail of the surgical plan.

In July 2022, when the time was ripe, the medical team successfully replanted the left lower leg, which had been banked on the right calf for over a year, back to its original position. To ensure the survival of the replanted limb, the surgery not only involved precise vascular anastomosis but also innovatively adopted a "cross-leg flap" technique, creating a dual insurance mechanism. Twenty-one days later, the flap pedicle was successfully divided, and the replanted limb survived, marking a critical success in this highly complex procedure.

Subsequently, the medical team performed sensory nerve reconstruction surgery on Xiao Pan's left calf. Using nerve grafting, a reserved 12-centimeter segment of the common peroneal nerve from the proximal left calf was used under microscopy to reconstruct the tibial nerve via vascularized anastomosis.     Six months post-surgery, Xiao Pan gradually regained sensation in the sole of his left foot and began walking without crutches while wearing a brace. "When I felt sensation in the sole of my foot for the first time, I was truly too excited to speak," Xiao Pan recalled.

However, the treatment journey was not yet over. Due to the bone defect, Xiao Pan's left leg was about 20 cm shorter than his right, making normal walking impossible without the brace. In July 2023, the Hand and Foot Microsurgery team, together with the hospital's specially appointed orthopedic expert Professor Peng Aimin, performed an Ilizarov bone lengthening procedure. Using an external fixator adjusted daily at a rate of 0.75-1 mm, they helped the left calf slowly and effectively regain length. Although this technique requires a considerable amount of time, it is minimally invasive, allows for rapid recovery, and enables the patient to exercise with the frame throughout the treatment. After a year of gradual lengthening, Xiao Pan's left leg finally returned to its normal length and entered the bone consolidation phase.

In August this year, after two years of limb lengthening treatment, review X-rays showed that both lower limbs were basically equal in length, with good bone consolidation in the left calf. The medical team removed the external fixator. At this moment, all the medical staff involved in the treatment breathed a sigh of relief. After four years and six months, seven hospitalizations, and twelve surgeries, this once nearly lost left leg had finally been reborn!

Upon discharge, Xiao Pan and his family were deeply moved. "Besides gratitude, I really have no words to express my feelings now," said Xiao Pan's mother, her eyes filled with tears. Xiao Pan himself stated, "I am extremely grateful to all the doctors and nurses in the Hand and Foot Microsurgery Department. For over four years, I have received their care. My emotions are overwhelming now that I am finally 'liberated.' Although I went through some painful rehabilitation, compared to a prosthetic limb without sensation, I believe all the persistence and waiting were worth it!"

This "battle to save the severed limb," lasting over four years, not only demonstrated the technical prowess of the Hand and Foot Microsurgery Department at Hainan Medical University Second Affiliated Hospital but also highlighted the advantages of multi-disciplinary collaboration. The entire rescue process, from the initial life-saving measures upon admission and the overnight emergency surgery for ectopic banking, to the mid-term replantation, and later limb lengthening, functional reconstruction, and rehabilitation, involved close cooperation from multiple disciplines including the Emergency Department, Anesthesiology, Operating Room, Intensive Care Unit, Blood Transfusion Department, Hand and Foot Microsurgery, Rehabilitation Medicine, Nursing Team, and related clinical support departments.

It is understood that the Orthopedics Department of Hainan Medical University Second Affiliated Hospital was established in 1952. It currently comprises 7 patient units, including Joint Surgery, Spinal Surgery, and Hand and Foot Microsurgery, with a total of 71 doctors and 139 nurses. The successful treatment of this case fully demonstrates the hospital's comprehensive strength in severe trauma care and will contribute to promoting the development of high-level disciplines in the Hainan region.

From critical rescue to functional reconstruction, from technological innovation to humanistic care, SHHMU used four and a half years to interpret its service philosophy of "Sincere Care, Warmth and Compassion." This road to rebirth is not only a medical miracle but also a vivid embodiment of the perfect combination of medical compassion and advanced medical technology.