A mammoth 10-hour operation at the Canberra Hospital this month involving world-renowned limb microsurgeon Professor Wayne Morrison has taken a Wagga Wagga farmer another critical step closer in giving him use of his right forearm and hand severed in a farming accident 13 months ago.
Adam Symons had been baling hay on his farm in October 2020 when the sleeve of his shirt got caught in the mechanism and dragged his arm in.
His arm was pulled off at the elbow yet somehow, in agony, he managed to drive the tractor down the paddock to where another person was working, and help was summoned.
In cases such as this, specialists say there is a very narrow window of time available to restore blood flow to save a severed limb - generally around four hours.
As Mr Symons was airlifted to Canberra Hospital, his severed limb was extracted from the baler, packed in ice and taken with him in the air ambulance.
A team of local surgeons, led by doctors Ross Farhadieh and Krishna Rao, worked for 11 hours to save the limb and have the blood flowing again.
Now, 13 months later, the complex reconstructive surgery has begun, with the transfer of muscle, blood vessels and nerves taken from his inner thigh - the gracilis muscle - into his forearm.
To assist in this complex microsurgery, Dr Farhadieh called upon the expertise of his mentor, Prof Morrison.
In 2011, Prof Morrison was the first person in Australia to perform the complex micro-surgery which attached a donor hand to replace one lost through emergency surgery needed to save the life of a 64-year-old Victorian man aggressively attacked by the pneumococcal bug.
In 2017, Prof Morrison also led the surgical team which successfully worked on former University of Canberra student Sarah Hazell, whose hand was nearly severed when her car rolled on the Kings Highway near Bungendore.
With Mr Symons' limb successfully salvaged, the next delicate step was to provide the musculature needed to regain his extension function, to allow his hand to move back and forth at the wrist and to extend his fingers.
"Professor Morrison is a pioneer in this form of surgery. He's my old boss and he trained me. He has a lifetime of experience in performing complex surgeries such as these," Dr Farhadieh said.
"So now his (Mr Symons') muscle is functioning and fine. The question is how that [transplanted] gracilis [inner thigh] extensioner musculature will begin to relearn the extension of his wrist and of his hand.
"This operation was about re-establishing function as much as possible. The aim is to give Adam as much as 40 per cent of his function back in his hand and forearm."
Dr Farhadieh said the patient's fine hand muscles had remained intact, and the transplanted nerves could be expected to grow back and re-establish themselves with those in his hand.
Mr Symons was already feeling sensations of hot and cold in his fingers, a good sign.
The high-end surgical skills and equipment available at the Canberra Hospital make it the primary treatment centre for not just the ACT, but much of the southern NSW region.
"At Canberra, we're the first port of call for trauma surgery such as this, from the Victorian border all the way to Sydney," he said.
Assembling the huge team needed for the lengthy micro-surgery was a complex logistics process.
Aside from Professor Morrison, Dr Farhadieh and Dr Rao, there were four other trainee junior surgeons on the team, an anaesthetic team of four and a "scrub team" of six senior nursing staff.
"This is a significant undertaking but the whole deal about the Canberra Hospital is that when it comes to these major reconstructive things, it works like a well-oiled machine," he said.
"Yes, there may be a lot of things wrong with our public health system but this stuff, which is the most important stuff, we have the wherewithal to do this at a world-class level."
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