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A 21-year-old woman from Samtse, Dechen Wangmo, sustained injury in July when she met with an accident, leaving her left hand paralysed.

Due to the injury to the artery and main nerve of her left arm, she was not been able to flex her fingers and lift her hand.

She was among some 60 patients that a seven-member team from Interplast Australia and New Zealand along with doctors at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) operated on this week at JDWNRH in Thimphu.

The team leader of the Interplast team who visited Bhutan last week, Dr Tim Proudman said Dechen Wangmo was referred to the Interplast camp because of the loss of nerve and tendon function in her hand and the extensive scarring she had suffered.

Orthopaedic surgeon with JDWNRH, Dr Ugyen Thinley, said that about 10 cm nerve was missing in Dechen Wangmo’s injured hand when she was brought to the hospital after the accident.

Dechen Wangmo said her life changed after the incident.

She started working in a resort in Bumthang in March this year after she completed her Class X.

“ I am dependent on my friends to do simple work like washing clothes.  I feel handicapped because I cannot even tie my hair,” Dechen Wangmo said. “I haven’t told my parents about the accident because I don’t want them to worry about me.”

Dr Tim said she did not have feeling or movement in the thumb, index, and middle fingers.

“It was not possible to repair the nerve directly or undertake a nerve graft because of the scarred wound bed which would not allow it,” Dr Tim said. “This would be the more conventional method of repair but would require resurfacing the wound with a skin flap which is not possible in Bhutan at the moment.”

The doctors had her left arm tendon and nerves repaired on October 23. The surgeons transferred the nerve of the thumb index and middle fingers to the side of another nerve.

Dr Tim said it would have a good chance of stimulating this nerve to recover some function and give protective sensation to the affected side of the hand. “We also connected some of the tendons to others so that the fingers can commence some movement.”

He said it would take six to 12 months to determine the extent of her recovery. “In the meantime, she will be helped by the hand therapist who will remain here for a week after our main team leaves to supervise management and help train local staff about the ongoing care that is required.”

The team hopes to follow her up on their biannual visit in April next year.

“I believe I will be able to hold things and do my work like before soon,” Dechen Wangmo said.

The team saw around 200 patients on their recent visit this year.

Dr Tim said that unlike some other camps, the full range of reconstructive procedures are possible for patients and include burns surgery, hand surgery, cleft lip and palate, maxilla-facial surgery, advanced wound management skin, soft tissue tumours, and head and neck reconstruction.

The patients are also assisted with post-operation therapy to maximise the outcomes, Dr Tim said. “In the future, we hope to introduce Microsurgical Flap Reconstruction as an advanced way to help treat complex cases.”

The team made a proposal to help train a local surgeon as a reconstructive surgeon.

The week-long camp ended on October 25. This is the sixth Interplast visit to Bhutan.

Dechen Tshomo

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