Friday, August 6, 2004
Glen Cove
Doctors reattach man's severed hand
BY ISABELLE HOOLEY
STAFF WRITER
August 5, 2004
It happened so fast, in a flash of steel and blood, that for a split-second all he could do was reel in pain and clutch his bleeding right limb to his chest.
Marcel DiMaggio was using a circular saw to cut a board for a cabinet he was building in his parents' garage last Wednesday night, when he suddenly lost control of the machine. As a horrible pain spread through his arm, DiMaggio, a grounds keeper for the Jericho schools, knew he'd cut himself, probably badly.
"All of a sudden the whole door [to the garage] was pounding," said Charles DiMaggio, Marcel's father. "And there he was, screaming, 'Take me to the hospital.'"
"What did you cut, two fingers?" Charles DiMaggio said as they sped from the home Marcel shares with his parents in Glen Cove to North Shore University Hospital at Glen Cove. But Marcel, 35, was hysterical and the car was dark.
When they stepped into the hospital's emergency room, DiMaggio saw for himself.
Marcel had no hand.
DiMaggio sped the four minutes back to his home, praying the whole way. His wife, Angela DiMaggio, wanted to know why he was back so soon.
"I've got to get the hand," he said.
She screamed and he ran into the garage to retrieve it where it lay on the floor.
Back at the hospital, medics packed the hand in ice before loading it and DiMaggio into an ambulance for transfer to Nassau University Medical Center in East Meadow. Within minutes of arriving at NUMC, DiMaggio was in surgery.
Dr. Michael Stracher, an orthopedic surgeon trained in limb reattachment, said he'd done many fingers but never a hand.
"When we got the call, I said, 'We better get the team together,'" Stracher recalled, adding that only a few surgeons on Long Island are trained for the procedure, sometimes called replant surgery. The surgeries tend to occur more frequently in rural areas where there is lots of farm machinery, Stracher said.
Stracher and his team of about six surgeons and assistants worked for about 18 hours, he said, using a microscope to reattach fibers with sutures that were at times as fine as a hair. After sewing together tendons and blood vessels, they took tissue from DiMaggio's left ankle to reattach a nerve in his wrist.
Surgeons said Marcel's hand was so swollen they could not sew it shut completely, so they took skin grafts from his left thigh to place on both sides of his wrist. When the swelling goes down and the skin heals, the transplanted skin will contract, they said.
The reattachment of the tissues was made easier by the cut's clean lines, Stracher said.
Marcel, whose last pain-hazed memory before surgery was sucking air through an anesthesia mask, awoke on Friday.
"From the very time I woke up, I could move [my fingers]," he said yesterday morning as he was being discharged from the hospital. As he spoke, his swollen and slightly yellowed fingers wiggled above a foam pad and a series of steel pins inserted for temporary support because the circular saw shattered some of his wrist bones.
The pins will be replaced in a few weeks by a permanent plate for structural support, said Stracher. It means DiMaggio won't get back full flexibility and mobility of his hand. But in a year or so he should be using it in a limited fashion, Stracher said.
Yesterday, just before DiMaggio went home, Stracher shook his injured hand for a photo opportunity.
"I feel the pressure, it's tingling right now," DiMaggio said, smiling. As he left the hospital, he was asked if he planned to finish the cabinet.
"Yeah," he said, nodding his head emphatically. "When I get better, I plan to finish."
Hands-on surgery
Surgeons at Nassau University Medical Center reattached the severed right hand of Glen Cove resident Marcel DiMaggio in a complicated 18-hour procedure.
1. ACCIDENT
While making a cabinet, DiMaggio severs his right hand at the wrist with a circular saw. The proximal carpal bones are "obliterated,'' according to a surgeon.
Preparation
One team of surgeons evaluates the hand; another evaluates the stump.
2. SURGERY
External fixators, or pins, are attached to the radius and ulnar bones in the arm and the metacarpal bones in the wrist.
Plastic surgeons then reattach the radial artery, allowing blood to .flow back into hand and preserving tissue.
Radial artery, ulnar artery, veins, tendons and nerves are sewn back together. The sural nerve from DiMaggio's left ankle is transplanted to replace the ulnar nerve in his wrist.
Two 5-by-5 cm. pieces of his left thigh are transplanted onto both sides of his wrist.
3. POST-SURGERY
In two weeks, a metal plate will replace external fixators in wrist area. He faces lengthy rehabilitation.
