Doctors reattach hand of crewman

Man thought hand was lost cause after accident with fish saw

Posted: Wednesday, February 06, 2002

SEATTLE - The day after a worker's hand was severed on a fishing boat in the Aleutian Islands, surgeons reattached it and are increasingly hopeful about his chance of success.

"I thought it was gone," Patrick Laulu said Tuesday, pinching the lower part of his bandaged right arm, "but no - so I'm happy."

It took more than 24 hours to get Laulu to the operating room after his hand was severed by a fish saw.

Shipmates applied a tourniquet and injected him with morphine as he waited for a Coast Guard rescue helicopter that flew nearly 500 miles over the open sea as winds gusted to 55 mph amid swirls of snowfall and eight-foot seas.

Usually, muscles die from lack of blood after several hours and release toxins that can be deadly after a hand is reattached, said Dr. Tom Trumble, a surgeon who directed the complex operation Friday at Harborview Medical Center.

"I don't know if a hand has been put back on after 24 hours," Trumble said. So far, he added, "things seemed to have worked out."

A report on the unusual operation was published Wednesday by the Seattle Post-Intelligencer.

Laulu, 37, was on his third tour aboard the 238-foot trawler Alaska Juris, working with 35 others on a catch of mackerel about 100 miles west of Adak. He was manning a heading machine belowdecks when he noticed a fish rake sliding along the floor.

He reached with his left hand to grab the rake, keeping his right hand on the stainless-steel table that is part of the heading machine.

"A big wave hit the boat, and the boat moved," Laulu said. "A belt pulled my hand underneath the saw blade. I didn't know my hand was off. It just hurt a little bit, then it was numb."

Laulu's shipmates, trained in first-aid, raised his arm and tied a rubber tube below the shoulder to stop the flow of blood as a Coast Guard flight surgeon advised them by radio on proper tourniquet procedures and application of morphine to ease the pain.

The severed hand was placed on ice.

"I was thinking about God. I said a prayer, asking him to help me through this accident," Laulu said.

A helicopter was dispatched from St. Paul in the Pribilof Islands, north of the Aleutians, for a 390-mile flight to Adak Island for refueling, and then a westward flight to the Alaska Juris, arriving at 1:30 a.m. Friday.

A rescue swimmer, lowered to the deck of the trawler, got Laulu into a basket and he was taken to Adak, placed on a Learjet and flown to Anchorage for an initial round of hospital work.

At 4:30 p.m. Friday he arrived at Harborview, the nearest major trauma center. By then he had lost as much as a third of his blood.

The odds for success were poor, but Laulu had three factors in his favor - the clean cut made by the razor-sharp saw, plenty of ice to preserve the hand, "and the last thing is luck," Trumble said.

Trumble, a hand surgeon for 15 years, began by removing from the severed hand small muscles that perform functions such as spreading the fingers, to reduce the chance of a toxin release or infection.

Then the team tagged the nerves, tendons and arteries, a task that accounted for nearly half the total procedure.

Finally, using pins and sutures with the aid of a microscope, Trumble reconnected two arteries, three veins, 16 tendons, five bones and two nerves to fit the hand back onto the wrist.

The surgeons remain cautious but are encouraged by Laulu's lack of a fever.

If this round is a success, Laulu will face more surgery and rehabilitation. At best, Trumble said, Laulu will regain some use of his hand but not small-motor functions such as writing.



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