Rejoined at the Ankle

Able Seaman Liang Chin-kai 23, was working on the deck of a tugboat in Canton harbor when he got involved in a classic accident that is dreaded by all sailors. His leg was tangled in a towing cable that suddenly snapped tight, all but amputating his right foot at the ankle joint. At Chung Shan Medical College Hospital No. 1 two hours later, Doctors Huang Cheng-ta and Li Pingheng, both 36, were faced with an extraordinary operation: the restoration of a foot attached to Liang's leg only by shreds of muscle, tendon and nerve. In the first report of their work to circulate outside Communist China, the two surgeons calmly spelled out their startling achievement.

By the time Huang and Li were ready to operate, the temperature of Liang's severed foot had fallen 15DEG lower than that of its unaffected mate. Quickly, both foot and leg stump were carefully cleansed. An anticoagulant salt solution was forced through the foot's major arteries to flush small blood clots and other circulatory blocks. The lower ends of the two leg bones, the tibia and fibula, as well as some of the talus or anklebone, were trimmed, and two stainless-steel nails were driven up through the heel into the tibia (see diagram). With his ankle fused, Liang's right leg was shortened by 3 cm.

Next, the doctors rejoined the posterior tibial artery; it was 51 hours after the injury that blood began to flow back into Liang's foot. The anterior tibial artery and three veins were quickly rejoined, muscles were sutured, the Achilles' tendon was repaired, nerves were retied, and a 130-sq. cm. skin graft was laid over the torn-up area around Liang's ankle. The entire operation lasted eight hours. The skin graft survived, and within two months the replaced foot was well enough to begin physiotherapy.

After seven months, the wounded seaman could walk for several hours, flex his toes, feel pain and temperature changes, climb stairs, stoop down, and even kick a soccer ball. The stiffness of his fused ankle seems the only irreparable aftermath of his accident.

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