Ansh and Foot

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Ansh lives in village near Farukhnagar, he was 15 year old boy who was studying in class ninth in a near by school. He had given papers of class nine and was helping his grand father in fields .It was hot summer morning he was in fields with his grand father.  Grand father was driving tractor in fields and he was sitting on the side seat of tractor. They stopped tractor to do some adjustment to harrow with which they were ploughing the fields. After finishing their work they were disengaging the plough and Ansh foot slipped over sharp blades of harrow. Hot sharp blade wasted no time in separating foot from leg it accompanied by ferocious bleeding . Grand father and boy panicked quickly they arranged tourniquet to stop bleeding. Being alone in fields added to misery. They rushed to nearest doctor for medical help , who after dressing the wound referred them to district town of Rewari. At Rewari they were apprised of seriousness of injury , possibility of amputation.
 They were looking for hope and decided to try their luck in Artemis hospital Gurgaon. At Artemis not much hope is given to them, they bolted in a hurry towards fortis gurgaon after being advised to do so. In fortis first orthopaedic team led by Dr Balwinder Rana saw him and decided to include vascular surgeon for possible repair of vessels. Vascular surgeon Dr Surinder Khatana was very pessimistic about outcome of arterial repair and limb salvage. In the end plastic surgery opinion was taken whether we can do microvascular repair , when I saw the patient it was 2.30 pm and injury occurred 6,30 am in morning. I was optimistic but was bombarded with  guarantee of success  questions .
 Talking to north indian male loaded with testosterone can be a difficult task. They literally harass you , try to demean you and are usually uncouth. I told them surgery  offers hope not guarantee.Amputation and death are only guaranteed things in life . Money spend in treatment can be earned back but foot lost will be permanent. This clicked with his grand father who agreed and said we go with my plan.Financial counselling was done and blood sample were send for testing .

OT was informed ,I called up Dr Balwinder who was hesitant but readily agreed . Patient was shifted to OT , ortho team informed , initial hesitation turned into great enthusiasm every one in OT was perked up. Ortho team started working feverishly Balwinder asked for twenty minutes , I was arranging things for my part of surgery. I can see excitement on each one of members of surgical team. Each one of them from OT manager charan to gda was working overtime to cut delay and expedite as soon as possible. It was paying dividends also, microscope was brought and prepared.Anaesthesia team was very supportive and doing their best to optimize patient ,emergency surgery is always risky.I called up Dr S Khatana, to come and assist me.I also scrubbed and started harvesting vein grafts for the arterial repair. First we repaired anterior tibial artery and repaired anterior compartment tendons. Foot immediately pinked up and started bleeding , then we repaired posterior tibial artery, Dr Khatana  un scrubbed and left, Dr Behl joined me. By this time bleeding was in full tempo so I decided to close the wounds and call it a day. Posterior tibial nerve repair was left behind for another day. Ansh was extubated and shifted to ICU 4, for monitoring. We were exhausted and left for home.On the way home I had discussion with Dr khatana about case. Overnight bleeding slowly ebbed and next morning, Dr Behl gave a positive picture .Slowly patient stabilized and was shifted to ward . Anticoagulant therapy and monitoring was required in these cases. On the day 4 post operative we did skin grafting over raw areas and next day we discharged Ansh.We gave him five units of blood during whole admission and kept him in followup.
He was kept in regular followup with regard to bony union and healing of other wounds .

On 3/6/17 I admitted him and did his nerve repair and removed his external fixator and after one month removed all the sutures . His tinel's sign was progressing when last seen in august.







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