Jay Paul photo
George Barry had planned to go fishing on a Thursday in late January near his home in Brunswick County. Instead, around lunchtime he visited his buddies at a construction site. "[I thought I would] go over there and tease and tell them, ‘Wouldn't you rather go fishing with me than work?' " he says with a jovial smile. He had retired after more than 40 years in construction, painting and carpentry. But 60-year-old Barry, whose friends call him "Tiny," decided to jump in and help rather than watch his friends climb up and down from the rafters.
Using a miter saw, he cut a few 2-by-4s, but when he reached for another plank, he somehow miscalculated and the blade sliced his left hand off at the wrist. "It happened so fast, I don't know what happened," Barry says. "Just like that, my hand was going across the floor."
In a flash of excruciating events, Barry says he lifted his left arm above his head to slow the bleeding, and one of his friends pulled off a leather belt and wrapped it around his upper arm. Amazingly, the cut from the saw had twisted his long-john shirt around his arm stub and created a mesh tourniquet. Barry says he did not panic but was thinking, "I have really done it this time." He adds that while he had crushed his back in a previous work accident, he had never known such severe pain. "There is nothing I can compare it to. … It was so intense."
One of Barry's friends picked up his amputated hand and placed it in a cooler with chilling beverages. Within 45 minutes, Barry was taken by an ambulance to a landing pad and transported to VCU Medical Center by helicopter, about a 15-minute trip by air.
In the operating room, two surgeons decided to reattach the hand. Dr. Robert Adelaar, a hand surgeon and chairman of VCU's Department of Orthopaedic Surgery, says that was possible in part because Barry had reached VCU within about an hour of his accident (up to about six hours is the maximum time lapse) and the cut was clean. Also, the hand was preserved well; the emergency crew put the limb in a bag of intravenous fluids to preserve it, and then placed it in a bath of ice, rather than placing ice directly on the hand.
Adelaar and Dr. Jonathan Isaacs, who heads VCU's hand-surgery division and Department of Orthopaedic Surgery, were not sure if Barry's vessels would be strong enough for the surgery, but they evaluated his health and elected to go ahead with what turned out to be a seven-hour procedure.
"He waved his stump at us when he went into surgery," says Penny Barry, George's wife of 31 years. "It looked like a whittled stick." Barry chimes in, "You have to have some sense of humor."
Surgery to reattach a hand is unusual, Adelaar says. He and Isaacs have only seen two other patients for that procedure between them in the past decade. In contrast, they see about four to six patients per month for finger amputations.
"A hand replant is a technically easier surgery than a finger replant," Isaacs says. "The structures you are working with are bigger."
Barry's microsurgery began with Adelaar fusing his wrist to his arm with a plate and screws, then repairing his tendons. The surgeons then used a microscope to repair his ulnar artery, the main artery in his hand, and began to see his hand "pink up," meaning that the blood was flowing through the arm to the hand and fingers and back.
"That is usually an emotional turning point," Isaacs said. "The clock is ticking, and you know you only have a certain amount of time to get the blood back to the tissue."
They attached Barry's radial artery, then reconnected his veins and finally, his nerves, microscopic repairs as well.
After four weeks, he lost his thumb from lack of blood circulation. But in the next few months, Adelaar says, doctors hope to move one of Barry's toes surgically to his hand to act as a thumb.
For now, he is attending therapy twice a week. "I'm beginning to have movement," he says, moving his fingers slightly back and forth. Barry, who is right-handed, will never regain motion in his left wrist, but Isaacs estimates that he may be able to bring his fingers down just 4 centimeters above his palm. Some patients have regained full range of motion, he adds.
Barry already has plans for his recovery. "As soon as I get these fingers working again, I'm going to ride my motorcycle."