The groin flap, still attached to the pedicle of skin which contains the artery and vein to keep the flap alive while the new blood supply from the hand develops.
Three weeks later, after division of the pedicle. The new blood supply comes from the surrounding healthy tissues in the hand.
Jack, on the day he believed.
Jack, with his surgeon, new Swahili bible (and "Kick-A" T-shirt)
One of the phrases we use regularly on the orthopaedic
service at Tenwek, which seems to perfectly encapsulate the peculiarity of the day-to-day cases we see here, is “You just can’t make this
stuff up.” Last month, a 40 something
year old man (who I’ll call George) presented to casualty with half his hand
blown off by a stick of dynamite.
Apparently, Jeremiah was correct when he insisted that there is gold in
the hills around Western Kenya (at one point when he was younger, he wanted to
ship a large sluice so he could pan gold from the Tenwek river). The patient had lit a fuse (yes, a fuse) on
a stick of dynamite and when it didn’t ignite, he went to inspect, and just as
he reached out his hand to grab the stick, it exploded and completely blew off
his thumb and index finger.
Covering large hand wounds such as this can be
challenging. But one of the described
methods in plastic surgery literature is with a “groin flap” in which a full-thickness
paddle of skin in the groin region is elevated with its blood supply within a
pedicle and then draped over the defect to supply new skin to the region of
loss. The hand needs to remain still for
three weeks while a new blood supply “takes” and so to accomplish this, the hand is
literally sutured to the groin. Then,
after three weeks, the pedicle is divided and the hand “freed.”
During George’s three week waiting period, a young man named
Jack was admitted to the bed next to him with a neglected open, segmental distal
tibia fracture from a motorcycle crash.
He was first admitted to another hospital where he literally sat without
care for 5 days, until his sponsor (who I providentially met at an Indian
wedding last February) insisted that he be taken to Tenwek. After several operations, including the
placement of an external fixator (pins, clamps and bars), Jack was on his way
to recovery.
While on morning rounds one day, I asked Jack and George if
they were Christians, and Jack very honestly answered ‘no’ but was interested in hearing more. So, we made
plans to meet later that day. But as the
work typically goes, I was completely slammed, and had no time to meet with
Jack. Unfortunately this scenario
happened for the next three days, each day on morning rounds telling him I
would find him later, and each day, loosing the opportunity because of
work. Finally, one evening I had time to
have a cup of chai with Jack in the hospital canteen. Jack explained to me that he was orphaned at
age three when his parents were both killed in a car accident, and he literally
lived on the streets from age 3 to age 15.
Then, he was “rescued” by his sponsor, a Hindu woman who helped him
through school, and on to his current employment as a DJ. I explained to Jack that Jesus came for all
people, regardless of race, religion, color, background, etc., because we all
desperately need a Savior and that through the forgiveness of sin that He offers
through His death for us on the cross, we can now have hope. Right then and there, Jack said he believed,
and prayed one of the most honest, cool prayers that I have heard in a long
time.
Through the randomness and oddities of the cases we see
here, mixed with the busyness of work and life, we see glimmers of God’s grace
(which continues to amaze). Please keep
Jack and George (and all our patients) in prayer that God would heal and
restore physically and spiritually.
Thanks for all your support and prayers for our family!
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