Limb to crotch (updated)

Israel Sarrío arrived at the Rehabilitation Center of Levante from Hospital Peset in Valencia (Spain) on January 31st of 2004 with an amputation of the left arm 2 inches above the elbow.

Amputated ArmTrunnionrx
Click on images for large size

At 14:00hrs, the microsurgery implant began. The first maneuver consisted in lavage and sterilization of the amputated arm and its connection to the brachial artery by a silicone tube in order to revascularize it.

Later we rebuilt the humerus and repaired the brachial artery, the basilic and cephalic veins, and the three nerves of the arm.

This proccess lasted 21 hours, and the reimplantation was successful. The patient went to the Intensive Care Unit during that night and the next day, he went to a normal room.

first implant

Two days later, we found a wound infection that was seriously compromising the viability of the reimplantation. We talked to the family and they told us that the day of the accident the arm fell in a drain. This contamination was the probable cause of the unfavorable progress. The situation was critical, and we said to the family that there were two different options: reamputate the arm or try to save it by taking it into a healthy zone where it would be possible to nourish it while we cleaned the infected area.

wound infection

The idea of taking the arm to another anatomical location came by reading a similar case published by Michael Wood (Mayo Clinic, Rochester, MN, USA) in which he attached an arm in the groin. The uniqueness of our case consisted of using the procedure to rescue the limb from an infection, called a Deferred Transitory Heterotopic Implant. This was the first such case of involving an elbow.

With the agreement of the family it was decided to transfer the arm to the groin where large blood vessels are readily accessible. In 4 hours we disassembled the reconstruction performed earlier and connected the blood vessels of the arm to those of groin by means of microsurgery.

implant in dangerleg implantleg implantleg implant

The psychological impact on the patient was very important. As soon as he woke up, we told him that the arm was infected and we have to save it in other location on his body. After a couple of hours he realized that the arm was on his leg. He stayed that way for nine days with daily cleanings until it was verified that the stump was clean.

On February 12nd of 2004, we reimplanted the arm in its original place, rebuilding bone, arteries, veins, nerves, muscles and skin in a procedure of 6 hours.

replantpost replant

Afterwards, the patient was doing physically and psychologically well, happy that he have not have to lose his arm.

By this time the patient could move his elbow. From the time of the surgery, the repaired nerve functionality is growing at a speed of 1 milimeter per day. In about 6 months we hope that he will be able to move his hand and fingers.

The function which we hoped to obtain from this procedure was better than those obtained with an amputation and the prosthesis. The patient will be able to grasp objects, to perform normal life functions, such as tie his shoes, all with small orthopedic aids.

final status

The complete surgical team of the Unit of Hand and Reconstructive Surgery was involved in this operation, with Dr. Pedro Cavadas leading the team, and Dr. Navarro, Dr. Soler, Dr. Duke and Dr. Landin as assistants.

Via

57 thoughts on “Limb to crotch (updated)

  1. MOM-IDEA

    very nice article, this is the wonder of Human being.
    Body Manipulate is very extremely thing to see and most uncommon in everywhere.
    Thanks for Sharing Great Story !!

    Cheers !!!

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  4. Sam

    You should post some update now! I am very astonished and interested in the operation and the results.

    Gread work!

  5. chris

    congrats on the hole thing. soon enough we may figure out the human brain. i may live to see the first brain transplant into another body. although i don’t think that would ever have a practical use. although you may tell me “that’s not possible”. i reply “yet”.

    at the age of 16 i have the internet and with that the world in my hands.

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  7. Bobby

    This is Bobby,29 from Iran.I really admire the Doctors and generally the Surgery Team.It’s wonderful.This man and his familly must adore doctors and also do not forget God.
    I’d watched taking human ear to the back of a mouse once but these pictures here are great.

    Best Regards………….Iranian Bobby

  8. Cody

    wow u guys r the biggest nerds ive ever witnessed in my life

    u people need to get out more and get some friends

  9. sarah

    wow thats amazing
    i feel sorry for the guy but its just amazing what can be done these days.

  10. Marc Blanchard

    How wonderful it is to know that amidst this time of low resources, both human and otherwise, a group of medical professionals decided to spend both time and money to save one person’s arm. I understand that is also goes to advance medical knowledge and techniques but bottom line, they would have made a better buck by moving on to the next patient. So hats off to you all, you are the best example of what patient care is all about!

    I have personally been victim of malpractice and was left with nerve damage in my legs but, all is all, I am still a very fortunate man compared to most. However, it scares me to think of all the patients that must suffer because the dollar is more important than the patient. I do not remember any mention of finance or income when I took the Hippocratic Oath. Perhaps there are different versions out there!

    Again, great job, we could all use a reminder of what our profession is really about!

    God Speed!

  11. Becca

    I like the wide variety of comments this article got, both interesting, informative, and amusing… people should learn to take a joke… I mean, stop being so aloof, this guy did have a hand in his crotch. It is actually funny, as well as being an amazing and interesting medical story.

    Anyway, onto the real subject, this is amazing. Truly amazing what medical science can do. Well done to the doctors and I hope the patient is recovering well.

    On the less serious side of things… how cool would it be to be able to say “Hey, I once had my arm attached to my crotch!”

    Is that an ARM in your pants or are you just pleased to see me?

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  13. Laura

    It’s all been said… unbelievable, amazing, extraordinary, etc. I’ve never seen anything like this, and I would never have guessed it could be achieived/successful.

    I’ve sent this link to numerous family and friends, colleagues etc to marvel (adding a warning if reading on lunch breaks!). They’ve all been transfixed.

    Dr Mikel – you and your team deserve some kind of international, medical recognition for this creative work.

    Regards, Laura,
    Bristol, UK.

  14. Giulio

    I have a question for the medical community here. A friend at work recently lost 3 of his fingers in a terrible accident involving an auger on a snowplow. There was an infection problem and the docters here, placed his entire hand into his groin.

    He was quite shocked by this. I don’t think the medical team handled it well, because he feels that he is a guinea pig, so I think that they did not explain what they were doing properly.

    All I want to know, is if anyone has heard of this. This story seems very similar.

  15. B. Turner

    I find this so amazing that science has progressed this far. I sure hope god forbid if anything were to ever happen to me that the dr. would try something like this. It truly is amazing and I also would love to know if the patient was able to have much movement the arm. I say congrats to the doctors who cared enough to try this.
    One note: the people on here with the crude remarks. You are showing your inmaturity. Lets hope this never happens to you! I mean really, this is no place for children to post crude comments. Grow up!

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  20. Lisa the GP

    PS: as to why the patient ‘discovered’ his arm on his crotch instead of being told, if he had a dire infection prior to surgery he may not have had the mental status to understand the upcoming procedure. Post op, once the infection began to clear, there would have been no way to predict the precise moment the patient would wake up.

    My guess would be that he woke up, made a noise of surprise, a nurse ran in and said something along the lines of, ‘we moved your arm temporarily because we had to control an infection. We’ll put it back soon, don’t worry.’

    I’m sure it was freaky to be the patient. But I’m sure he’s glad to have his own arm.

    I would like to know how this worked out functionally in the long-term if you have follow up information

  21. Lisa the GP

    You guys have done a fabulous job here! YAHOOOOOOO!

    I hope that docs treating mine injuries around the world get a close look at your work. This sort of creative thinking could really save some limbs.

  22. txsmichelle

    Sepsis will occur even in the cleanest of environments. I contracted MRSA during spine surgery with no injury to the area, it was to correct a birth defect.

    The damage done by the staph, due to a DR. that would not treat the infection, was horrific. And 11 years later I still harbor MRSA in my body, suffer intractable pain and have a myriad of other problems from 5 years on IV antibiotics.

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  24. Sandy

    Lrodshy57, If you get squeamish over ‘medical miracle’ pictures don’t go to sites that have them. The actual pictures can help other doctors faced with similar situations in remote areas – along with trying to contact the Dr that did the procedure.

    These pictures are not really gross, and certainly NOT gratuitous! They are extremely educational and if 100% real as one gentleman pointed out the possibility’s they are doctored (no PUN INTENDED!) then I feel it would be quite a shame.

    What did surprise me instantly was the after the fact mention that the arm was lost and recovered in a ‘sewer’. I would have thought regardless of where the arm was lost – that extreme cleaning of the arm and wound would have been performed before putting it back on – the first time. Also, removing it without trying other means FIRST too would have been done.

    There are some anomalies to this story that is certain. But please be squeamish else where K?
    ~Sandy (medical studies student)

  25. WestEnder

    A very impressive example of modern surgical technique. Kudos to the surgical team and best wishes to the patient for his recovery.

    I heard of a similar surgery a few years ago in which an infant had a nevus covering almost all of one arm. The surgeon removed the arm’s skin and then sutured the arm under the skin of the belly. It stayed there for a period of time (several months?) until the skin of the belly grew over the arm naturally. Then it was de-sutured from the belly.

  26. Lrodshy57

    Such medical miricles deserve world-wide publicity! Pictures need NOT be so clear, drawings would sufice. Please keep us up on his current status/use of arm. Thank you.

  27. Sandy

    The joke had to be said – ya know with men their hand is spent in that area of the body more than most anyway right?
    So it was a natual move to put it in his groin.

    But even if he has minimal use of his arm, both pshycologicaly and physically he is better off with a real arm – his own, than a prostetic.
    -sandy

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  29. Amerikan

    I think it’s important to recognize the skill of these doctors. Transplannt and reconstructive centers are spread worlwide, yet actual amputations are very localized and not always where the world’s experts are. That was the case here, and the local md’s read the literature and did the best they could. congrats.

  30. Ernie

    uh, yeah. any chance this is a complete hoax? what the hell did they do? somehow anastamose the arm to the femoral vessels? seems kind of absurd.

  31. DXB

    Firstly, an amzing story – well done!

    I’d like to know, what kind of scars (both physically and psychologically) will this procedure leave on the patient?

  32. Angry Medic

    brilliant. such cutting-edge surgery is very inspiring for med students such as myself, especially studying in a cutting-edge environment. this kind of article is what belongs right in the theme of this website. I’m adding you to my blogroll.

  33. deeraeya

    Interesting story, and great pictures.

    I’m always astonished at the length of these operations, but in this tale something else interests me. You chose to let the patient discover his arm in his crotch himself? (You write that ‘he realized’ which I took to mean you didn’t tell him). Why was that? Wouldn’t it be a bit traumatic to discover that yourself?

    Thanks,
    James

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