A Surgeon's Handiwork
With Hope, Skill, Teen's Severed Extremity Reattached
By Marylou Tousignant

The doctors who first examined Thao Nguyen when he was rushed by ambulance to Fairfax Hospital's emergency room in the early hours of May 3 could only shake their heads at the magnitude of the task that loomed ahead.

Nguyen's bloody left hand lay wrapped in gauze; a twisted flap of skin less than half and inch wide was all that still connected it to his forearm. His wrist had been sliced clean through with a machete - the bones, tendons, arteries and nerves severed swiftly and surely by a blow he never saw coming, delivered by an assailant lurking in the midnight darkness outside his ex-girlfriend's house.

At the hospital, Nguyen's parents arrived and began their vigil, his mother sobbing uncontrollably, his father agonizing over their 19-year-old son's condition. Back in Vietnam, where the family lived until five years ago, it was inconceivable that doctors could have restored an amputated hand, and there was no reason to think the outcome would be different there. "But we hope a little bit," said Thoi Nguyen, Thao's father.

Hope came in the form of Franklin D. Richards, the plastic surgeon and microvascular specialist on call for the hospital that night. Richards, awakened at his home in Potomac, hurried to Fairfax, assessing what he faced even before he got a look at his patient. Based on what he'd been told on the phone, he said later, "I knew I was going to be in for some work."

Richards, who had trained at George Washington University, had done an occasional thumb or finger replant in his eight years as a plastic surgeon, but nothing approaching a total hand replantation. "This is very rare," he said, "the kind of case that…if you get one in your career, it's something." Physicians at Fairfax and other local hospitals could not recall a similar replant there.

As Richards took photos of the wound and outlined what he was going to attempt, Nguyen, pale and in shock from the trauma, thought to himself, "No way!" But with little more to lose, he gave his consent, and the operation began after 1 a.m., with Richards accompanied by a surgical team and the classical music he favors in the operating room.

For much of the next 19 hours, Richards and his surgical assistant painstakingly reconnected the blood vessels and tendons, working through microscopes. A section of vein from Nguyen's ankle was used to bridge the gap in the main artery to his hand.

Richards remembers thinking that if there were any positives to be had, it helped that Nguyen was young and healthy and able to tolerate a major blood loss and that the amputation was a "good, clear cut," leaving the tissue on both sides largely unaffected.

It would be three days before Nguyen became aware of his surroundings. When he did awaken, he saw the fingers of his left hand poking out of the surgical wrapping. They were pink. A good sign. An unbelievably good sign.

"I ask my mom, 'Did he really do it?' and she said, 'Yes.' I couldn't believe it," he said.

A few days later, Richards operated again, this time improving the hand's blood supply by temporarily attaching it to Nguyen's chest. After two weeks, the patient was released from the hospital. Then the waiting began. When would feeling be restored? How much sensation and mobility would he regain?

Meanwhile, Fairfax County police were moving forward on the criminal case against Nguyen's alleged assailant. A 16-year-old boy, a stranger to Nguyen but a friend of his former girlfriend's, was arrested on a charge of malicious wounding; prosecutors want to try him as an adult. His name was not released because he is still charged as a juvenile. The machete has not been recovered.

Nguyen, a 1995 Centreville High School graduate who was attending community college, told police he went to the girl's house that night at the invitation of the mother, who wanted to talk. He and the girl argued briefly, and Nguyen decided to leave. As he walked back to his car, the assailant struck from behind, slicing off Nguyen's hand with a single blow. Nguyen said he looked down, realized in horror what had happened and started to run, his attacker in pursuit.

When the two got to the front yard, the attacker started swinging the machete at Nguyen's head. With his good hand, Nguyen picked up a child's tricycle that was in the yard and used it to deflect the blows. As neighbors responded to Nguyen's screams for help, his assailant fled.

Police describe the attack as unprovoked and say the assailant "apparently got jealous that this guy {Nguyen} was there."

Fearful that the youth's friends might come after him, Nguyen has kept his whereabouts secret and plans to transfer to another local college this fall. A few weeks ago, the suspect made bail and was released pending further court proceedings.

About the same time, Nguyen got some good news when one day he suddenly felt "wiggling" in the palm of his left hand. "It felt weird, like there were little worms in there," he said. Sensation was returning.

Fran Berger Kahn, one of the two hand therapists who work with Nguyen daily, said: "He's doing so well, it's amazing. At first, I tried to have him do functional activities, and he was, like, 'I can't do that.' Then he came in one day and said, 'I can move my thumb!'"

Now, Nguyen has limited movement in his fingers, too, but no feeling in the tips, just the palm. During therapy, he practices picking up plastic cups and squeezing sponge blocks and putty. By the end of the hour-long sessions, his hand is shaking with fatigue, but he keeps at it because "it's for my good."

Kahn, who attributes Nguyen's progress to the additional exercises he does on his own at home, said, "If he wasn't doing that, he could give up on his hand working again."

As for how well Nguyen's hand eventually will function, Richards says it's too soon to know. Nguyen faces more surgery and therapy for the next two years. "At that point, we'll have what we have," the surgeon said. But he is hopeful: "If he gets 60 percent normal functioning back, he'll do fine. But I'm expecting much better than that."

At times Nguyen finds the slow pace of recovery frustrating, but he clings to the thought that he will get back to college soon, so he can get a decent job to help pay his medical bills, which are approaching $115,000. His mother tends the salad bar a local grocery store, and the family hopes her health insurance will cover some of that amount. But Nguyen and his father, who manages a fast-food restaurant, just shake their heads when asked how they will make up the rest. |

"After I graduate, " Nguyen said, "hopefully, I can use my hand to get a good job."