Hà Nội's Military Hospital 108 goes out on a limb for patients

November 19, 2023 - 08:09
A Hà Nội hospital is changing patient lives with its hand and arm graft surgery

by Nguyễn Mỹ Hà

On a fine October day, factory worker Nguyễn Đoàn Quý, left Military Hospital 108 in central Hà Nội, where he had been a patient for five months to rehabilitate after what had been a gruelling operation.

He made his way home to his wife and 8-year-old daughter in Trát Cầu Village in the city's suburban district of Thường Tín.

It was a special trip home for Quý, 30, who was hospitalised five months earlier having lost his right arm in a horrific work accident at a mattress manufacturing factory in 2021. At one point, he didn't know if he was going to make it. Now he's coming home again, with a 'brand new' forearm.

SPECIAL BOND: Dr Hoàng checks the function of Quý's hand each week when he goes to therapy at the hospital. VNS Photo Đoàn Tùng

Dr Nguyễn Thế Hoàng, the senior surgeon behind three recent and pioneering limb graft surgeries conducted at the hospital in recent years, said: "One day at 7pm when we were on duty at the hospital, we received a patient (whose name was withheld) with severe injury, where his right forearm was cut off, and his right shoulder as well as the upper arm was wounded badly. The forearm was preserved quite well by our colleagues in a district hospital, but the patient was in serious condition and our job was to keep him alive first.

"The injury was bad because the whole right arm was crushed under a brick-making assembly line, so all structures were crushed, all the nerves were split off, and so were the veins. There was no possibility to preserve the arm. The main focus then was to save his life."

The doctors diagnosed it as a multiple injury, with all the anatomic structures destroyed, and it was impossible to reconstruct any parts of the remaining arm.

MORE MOBILE: Quý has trained himself in delicate finger work such as texting messages on his phone. VNS Photo Đoàn Tùng

"Military Hospital 108 has been conducting a project on grafting organs, and grafting limbs is part of it. During the consultation, we concluded that the forearm from the elbow down and the hand was still intact, so we could use it to graft for another patient, who also lost his right hand. But before we could embark on giving the hand to a receiving patient, we had to have a long talk with the family of the potential donor. He needed to agree to gift it to a suitable receiver before we could do anything," said Dr Hoàng.

"We were lucky that the family realised the humanitarian meaning of the donation, and they were very noble and agreed to gift the intact part of the well-preserved forearm to a suitable patient."

BAND AID: On weekdays, Quý goes to Military Hospital 108 for therapy, where everyone knows him well. VNS Photo Đoàn Tùng

The doctors then saved the patient's life, and in a rare practice, had to temporarily graft the cut forearm to his lower limb, to keep hot blood running through it, while they screened other patients to find a suitable recipient.

"We finally kept the split forearm on the patient's leg calf for two weeks until all screening tests were done," said Dr Hoàng.

Hands on: A therapist works on each finger of Quý to stimulate muscle and tendon. VNS Photo Đoàn Tùng

A life changed for the better

"Among a handful of patients who could receive this graft, all we could say about Quý is that he's a young, energetic and positive soul. He still has a long life ahead of him. If he gets a new hand, he can make his life so much better," Dr Hoàng said.

"After a check with blood group, the skin tone and, most importantly, that the receiver has maintained good energy and desires the limb, then we must decide."

FINGER TRAINING: Quý must lift each and all of these wood pieces and drop them in a basket, then pick all of them back to their holes on the board again. VNS Photo Đoàn Tùng

The recipient's wishes play a decisive role in integrating the new grafted limb to function well with a new body. They need to be mentally prepared and willing to do physical therapy after the surgery.

Quý's wife, Lê thị Duyên, 29, told Việt Nam News: "I got a phone call from the military hospital in March, while I was travelling on the road and I burst out crying. I called my husband right then and we both were utterly happy because we didn't believe we could have been offered such an invaluable gift so soon."

Quý had a work accident in 2021. That year 5,797 workplace accidents took place, causing 602 deaths, and leaving 1,226 severely injured cases like his.

The pair went to the hospital the next morning to do all the required tests. "I never thought such luck would come to my family just like that," Duyên said.

Dr Hoàng remembers the day of the surgery well.

"Everyone was ready, all medical indicators were well-matched and carefully checked, and psychological tests and checks were done. The surgery took 11 hours to complete, from 7pm until 6am the next morning," he said.

Four teams took turns in the operation, which went well.

“We had to connect three nerves, six blood veins, two bones and 20 groups of muscles,” said Dr Hoàng who studied and worked for 10 years in Munich, Germany, before returning to Military Hospital 108.

"This was our third case of grafting a lost arm, and everything went well. Our colleagues knew their work well and things went smoothly from consultation to preparation, to surgery and recovery."

In 2008, at the Rechts der Isar Hospitalin Munich, Dr Hoàng was one of five principal surgeons in a 16-hour operation to graft two-arms for a patient who lost both in an accident. The surgery was so successful that the patient's life was turned around with him being able to use his new arms to perform daily tasks.

Medical advances

This surgery was among the best the hospital had accomplished, with Quý in good health, and recovering well. He can now pour water from a bottle, pick up small things, and put them back with his new hand. He can use a smartphone and text on the screen with the fingers of his right hand too. It's a modern miracle of science.

"I believe in a year he will regain all the functional activities he used to have before the accident," said Dr Hoàng.

Grafting the split hand onto the calf of a leg of the same patient for two weeks to wait for the recipient was something the hospital had never done before.

"If we didn't do that, then the cut-off hand could last only for six hours under normal conditions. Had we not done that, we would never have done the graft," Dr Hoàng said.

"When we grafted the hand to the calf of the patient, his leg still functioned normally. This method shall open a new door to nurture wounded limbs for a longer time to find a suitable limb receiver."

Dr Hoàng's method may have wider implications for surgery worldwide, as previously the only source of limb donation came from patients whose brains were dead. By trying to spare the still intact part of large limbs with the consent of living patients, there will be considerably more options available in the future.

"Today, wars and conflicts, natural calamities such as earthquakes, labour and traffic accidents all can hurt or wound people. We hope that our method can be used to help those in need, by giving a chance to people who lost their limbs to feel complete once again," he said.

Quý was very lucky to be the first patient to benefit from this method. He and his family knew how fortunate they were, and worked hard to make it function as smoothly as possible.

"I will work to be able to hold my motorbike handlebars again and drive my bike once more," Quý said.

TOUCHED: A handshake that changed Quý's life for the better after his accident. VNS Photo Đoàn Tùng

Physical rehab

"Quý was transferred here back in July," said a physical therapist who patiently opens and closes Quý's fingers. "Now he undergoes many different activities, such as pulsed electro-physical therapy, and others."

"Each time he comes, I'll give him a hand massage to make sure all the joints in his palm get to move. The aim of this session is to stimulate blood circulation in the right hand, warm up the muscle, teach them to move accordingly and get all the tendons working as well."

Quý will have to do this for a year and a half or two years from now on, depending on how diligent he is.

Now he is encouraged to do daily work with his hand, like picking up a glass of water to drink. Daily activities can also be therapeutic for him to train his hands and fingers to work properly. It takes time, but he is making steady progress.

Duyên said that after the surgery, what worried her the most was that her husband would feel too much pain because the post-surgery recovery would last too long.

"After surgery, the doctors told me it was 99 per cent successful," Duyên said. "Thank God, my husband's recovery is good. We had faith that he would recover well."

Duyên was under a lot of pressure due to the long treatment time that her husband was away from home. She said that she would feel worried and could not sleep and felt alone taking care of their 8-year-old child.

"Now that he's home, I feel all my worries and nervousness are gone. When I went to get him from the hospital, we were all thrilled," she said.

fDr. Nguyễn Thế Hoàng of Military Hospital 108 in Hà Nội shakes hands with patient Nguyễn Đoàn Quý after a successful limb graft operation. VNS Photo Đoàn Tùng

Back to normal

During Quý's treatment at the hospital, Duyên wanted to meet with the generous donor who had agreed to let his split arm be used in this way.

HOME SWEET HOME: Quý goes home at noon when his wife is at work and his child at school. He now can cook lunch with both his hands. VNS Photo Đoàn Tùng

"I met him to thank him and his family," Duyên said. "He was a bright young man, who had a very positive attitude in life. We had a great talk."

"I'd like to tell anyone out there who might have had an accident like my husband, to keep an upbeat attitude, be positive and courageous."

Quý has good reason to be positive.

"I'm back to work again," he texted. "I still work at my old company where I had the accident. My salary has been kept the same, but now I only work in the afternoon, as in the morning I have to go to the hospital for rehab." VNS