Applause for China

The 6,500 members of the American College of Surgeons who invaded San Francisco for their 49th annual scientific congress last week had gathered to trade progress reports in their varied specialties. But of all the operations that were discussed, few were treated with as much respect as one that none of the doctors had yet seen: the restoration of a severed human hand by Red Chinese surgeons. Judged by a recent report to the International Society of Surgery in Rome, and by a story in the current Medical World News, the Shanghai team achieved more success than any similar American effort.

Double Break. The patient was a 27-year-old man, brought to the Sixth People's Hospital about 40 minutes after his hand had been cut off in a factory accident. Though the amputating instrument was not identified, it is clear from photographs that it made a relatively clean cut, straight across, with no lengthwise tearing. This was a break for both patient and surgeons.

Still, the torn edges of the flesh, and the jagged ends of blood vessels, nerves and tendons had to be trimmed back. To give themselves room, the Chinese surgeons did something that their American colleagues consider very clever. They cut back the bones on each side of the break for almost a quarter-inch, thus preparing clean, smooth surfaces for joining.

Bone surgeons joined the radius (larger of the two forearm bones) with a narrow metal plate held in place by two screws driven through each end into the bone. The smaller bone was left to rejoin itself. Vascular surgeons joined the major blood vessels, not by stitching, which even the traditionally patient Chinese admit is difficult, but by turning one end up into a cuff over a tiny plastic ring and pulling the other end over the slight bulge.

No Staples. Just four hours after the accident, circulation was restored to the hand. From a cold pallor it turned to a warm pink, and its veins bulged with blood. Then began the far more tedious process of rejoining three nerves and 18 tendons. That the Chinese did this at once, instead of waiting weeks or months as is customary in the U.S., is considered highly significant. For the longer any part of the body is left idle, the less likely it is ever to regain full usefulness. The whole operation took seven hours. Americans say they could have clipped about three hours off the total time by using a stapling machine to rejoin many parts.

Next day the hand was hot and so swollen it seemed ready to burst. The surgeons cut gashes in the skin between the fingers and down the back of the hand, and applied strong salt compresses to draw the fluid out. Very smart, said the U.S. surgeons in their critique. The swelling subsided within a week. After two months the metal plate was removed, but the bones were healing poorly, so the surgeons packed in bone chips as a sort of cement.

After seven months the patient had enough sensation in his fingertips to detect temperature differences of two or three degrees Fahrenheit. He could write, play pingpong, pick up weights of more than 13 lbs., and wield a hammer with authority.

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