Courage at 15 : Youth With Reattached Hand Mends; Surgeons Praised

Before last weekend, Jason Pinches said, about the worst thing that had ever happened to him was the time he stepped on a nail and had to take a tetanus shot.

But on Saturday, while helping his father remodel the family’s new house in the East Bluff area of Newport Beach, the University High School 10th-grader accidentally sawed off most of his left hand.

Jason didn’t panic. With a presence of mind beyond his 15 years, he actually helped his father take steps to preserve the hand so that doctors at UCI Medical Center could reattach it later in a 15 1/2-hour operation.

“I was scared,” Jason said from his hospital bed Wednesday. “But God really helped me get through it. He was there with me every step of the way.”

Jason lost his little finger and he will need more operations, but doctors say that eventually he will regain most of the use of his hand.

When Jason called out for help after severing his hand, his father took off his shirt and tied it around Jason’s upper arm to staunch the bleeding. “It didn’t bleed that much,” Jason said.

The youngster, just a few merit badges shy of becoming an Eagle Scout, told his father that the hand needed to be kept cold. Paramedics were summoned and arrived within 5 minutes, and Jason and his ice-packed hand were flown by helicopter to the medical center.

He remembered his thoughts in the helicopter: “The sensation that I got was that it (the hand) just wasn’t there. I tried to move it--it’s been there my whole life--but suddenly it’s not there anymore. It was very weird.”

At UCI Medical Center, three reconstructive surgeons using microscopes went to work to reattach the severed hand before the lack of blood rendered it useless. The replantation team handles several cases a month, said Dr. Robert Bledsoe, one of the surgeons who operated on Jason.

“You usually have about 6 hours (after the hand is removed from ice) to reconnect at least one blood vessel, or it’s not worth it,” Bledsoe explained. “In his case, I think it was 5 hours at the most before he was hooked up.”

Before they could reattach the hand, the doctors had to identify all of the nerves, blood vessels, tendons and bones on the limb and on the severed hand.

Bledsoe and Dr. Bruce M. Achauer used colored thread to “tag” the various parts of Jason’s palm, while Dr. Peter Witt worked on the amputated hand. Once that was done, the surgeons painstakingly sewed the parts back together, using microscopes and sutures smaller in diameter than a human hair: first the bones, then the tendons, the arteries and the veins. They also implanted an artificial joint in Jason’s ring finger.

Because of the damage done by the saw blade, the doctors had to borrow part of a vein from Jason’s forearm to reconnect the hand arteries, Achauer said.

The nerves were sewn back into place but will not be reattached until the doctors operate again in 2 to 3 months. They will harvest nerve material from other parts of Jason’s body to complete the grafts, the doctors said.

Jason’s father, John L. Pinches Jr., said the family has lived in Irvine for 21 years but recently bought a home in Newport Beach and planned to move in a few months.

Jason learned to work with power tools in shop classes and from his father, a painting contractor. Saturday afternoon, he was using a miter saw to cut molding for a door frame in a bedroom of the new house when the saw “just pulled my hand with it,” Jason said.

His father was in another room of the house when he heard his son yell, “Dad, I cut my hand off!” Pinches said.

“I was around the corner, and I went in and helped him hold his arm up,” Jason’s father said.

A planned family ski trip to Lake Tahoe is off for now, Pinches said. So is their move into the new home.

“I honestly don’t think we could move in it now,” he said. “I think we’ll just stay where we are.”

Jason and his family credit the doctors and nurses at the medical center with doing “a wonderful job.” But he already is anxious to go home. The hospital staff is terrific, but he is bored, Jason said.

He should be released next week and after Christmas break will return to school, where he was a goalie on the junior varsity water polo team. Jason doesn’t know when he will be able to return to sports, but he is anxious to begin the arduous months of physical therapy that lie ahead, he said.

“It’s going to be hard, but I think I can do it,” Jason said.

Looking at the huge white bandage encasing the injured area, he said: “I’m looking forward to having my hand back.”

REATTACHING SEVERED LIMBS Limb replantation surgery is performed only at a few large hospitals in Southern California, such as medical centers operated by UCI, UCLA, UC San Diego and Loma Linda University. In a typical operation, doctors use colored thread to “tag” the various tissues of both parts of the severed limb--bones, blood vessels, nerves, and tendons--before sewing them back together with suture barely visible to the naked eye. Aided by an operating microscope with two sets of lenses suspended about a foot above the patient, two doctors sit across from each other at the operating table and work simultaneously.

Factors that determine whether the operation succeeds are:

The cause of the injury. The cleaner the cut, the better. A hand cut in a straight line by a meat cleaver is much easier to reattach than a hand partially crushed, or mangled, in a machine or auto accident.

Time. Severed fingers and hands remain salvageable for about 6 hours at room temperature, up to 24 hours if kept cold. Larger body parts such as legs and arms must be reattached sooner because they contain far more muscle tissue, which deteriorates rapidly without a flow of oxygen-carrying blood. Thus, fingers and hands are much easier to reattach than whole arms or legs.

The age and condition of the patient.