The story of Sagar, A self made agriculturist

The story of Sagar, A self made agriculturist

Sagar, a self made agriculturist, chose agriculture as his profession after completing post graduation in biotechnology instead of migrating to city and working in the ubiquitous multinational companies. He started his journey in the 5 acre land that his father owns, by working with his father. Unfortunately his journey met with a hiccup in the initial part itself when his hand and forearm got stuck in the maching used to make bundles of hay and part of his forerm was crushed with some skin and the underlying muscles, tendons and blood vessels getting avulsed in the process. 

There was a vascular insufficiency of the the right forearm and hand with loss of function of the hand. On doing a CT Angiography there was damage to the vasculature at the level of bifurcation of the brachial artery along with damage to the flexor muscles and tendons.

The process of reconstruction was started along with the vascular surgeon Dr Devender singh

Structurally there was avulsion of the complete mid segment of the ulnar artery and severe contusion of the radial artery. Debridement was done and the dead and devitalised muscle was excised along with part of the tendon. There was segmental loss of Flexor pollicis longus, Flexor tendons of Index and middle fingers leaving a small stump at the level of flexor retaniculum till the musculotendinous junction along with some muscle. Devitalised skin and the rest of the soft tissues were also excised. After the debridement was completed, Ulnar artery was repaired by a vein graft, and the contused part of the radial artery was excised, and was repaired combining with thrombectomy. After the vascular repair, the piggyback repair of the stumps of the tendons of the FPL, FDS and FDP of the index and middle fingers was done with flexor tendons of the remaining ring and little fingers to preserve the function of the tendons.

The repaired vessels were covered with the adjoining muscles, and the rest of the wound was dressed. 

Once wound is stabilised and wound was assessed and a decision to do free flap was taken to cover the wound. The reason to chose free flap was to cover the tendons of the fore arm and also to provide a stable skin cover for further tendon transfer if needed. 

An Antero lateral flap was done with flap taken from the right thigh and the vessels were anostomosed with radial artery. 

The flap survived well. After the flap was healed well physiotherapy was done for the hand so that the tendon function will be restored. 

There was complete restoration of the function of the wrist and the fingers including that of the thumb.

we were able to bring back his hand function to normal, thus restoring his confidence to restart his dream of agriculture in his farm. We wish him best of luck and may he develop his farm in leaps and bounds