Surgeon delivers kindest cuts

Surgeon delivers kindest cuts

A challenging job can provide great satisfaction, PHILLIP THOMSON writes

CHARLOTTE YING loves to cut into people. People come to her with skin taken from the entire bottom half of a leg or with disfigured faces, but mostly she deals with injured hands.

''I love operating, I love cutting and making everything look pretty - if you ask any surgeon here they'll say they like all that,'' says Ying, a plastic surgery registrar at Canberra Hospital.

Dr Charlotte Ying is a plastic surgeon at Canberra Hospital and has seen an increase in hand injuries from workplace accidents.

Dr Charlotte Ying is a plastic surgeon at Canberra Hospital and has seen an increase in hand injuries from workplace accidents.Credit:Colleen Petch

Aged just 28, she has been in the ACT for three years and has seen a large spike in the number of patients going into the operating theatre. About 400 surgeries have been performed in her unit in the past three months, compared with about 300 in the same period in 2011.

Seventy per cent of these are hand injury operations.

Dr Charlotte Ying is a plastic surgeon at Canberra Hospital and has seen an increase in hand injuries from workplace accidents.

Dr Charlotte Ying is a plastic surgeon at Canberra Hospital and has seen an increase in hand injuries from workplace accidents.Credit:Colleen Petch

The largest proportion of Canberra's hand injuries happen on work sites. The worst case Ying dealt with recently was an 18-year-old man who stuck his hand into a concrete mixer six weeks ago.

''It split his middle finger down the centre,'' she says.

A description such as this sends tingles down the spine but Ying's voice suggests she has seen enough of these gruesome scenes to be able to disassociate from them.

''At first I did warn the patient and his mother we might have to cut the finger off,'' she says.

Bone, flesh, nerve, the middle knuckle and an artery had been cut away by the mixer - and were never found again - and gravel had become embedded in the rest of the man's finger but she saved it in the end.

''He can move it now and it looks quite nice,'' she says.

Ying, a Canadian who moved to the territory via Ireland, plays an important part in the Canberra construction industry.

A man who meets Ying in the emergency department may be in too much pain or shock to realise the role she will play in the rest of his working life.

A future career in a manual industry often rests on her skills at reconnecting tendons and bloodflow, sometimes reattaching a whole finger.

In the past year, the ACT accounted for less than 1 per cent of the building and construction activity that occurred nationally but almost 12 per cent of the fatalities, putting it well behind the pack in workplace safety.

Usually, the first casualty of poor safety around power tools on a building site or at home is the human hand.

In February, Canberra man Ali Arezi accidentally cut his left thumb off with a circular saw while woodworking in his Kaleen home.

It was reattached within the crucial six-hour time frame - the time it takes for the cells to die - by the Plastic, Reconstructive and Hand Unit at Canberra Hospital.

But microsurgery can't save all severed digits.

In July a man working at the Cotter Dam sliced off 2.5 centimetres of his left middle finger while cutting a piece of timber with a circular saw. The finger could not be put back on the hand.

The hand, a small area with a lot of moving parts, is a complex object for any medical specialist to work on.

In the words of Garran occupational therapist Sue Witchalls, the hand plays a major role in placing humans at the top of the food chain.

As well as having 29 muscles and 27 bones, it is one of the most sensitive parts of the body, roughly equal with the lips, and needs to work with a great deal of accuracy.

Witchalls asks patients to squeeze sponges or pick up pins and uses the latest techniques to trick the brain into moving the hand again.

One involves a mirror box.

The person puts their hands on different sides of the box and moves the good hand. The box makes it look like the injured hand is as flexible as it once was and this actually stimulates it.

Witchalls, a therapist who for 20 years has taught people to use their hurt body parts again, says she turns away up to 10 patients a week with hand problems.

Therapists able to work on hands are in short supply.

Strange, when you think of how important the hand is to daily life.

Think of typing, feeding a child, opening a door or playing the piano.

Ironically, it is sometimes the hand's own mastery which gets it into trouble.

Remember the high level of dexterity needed for a woman in the kitchen slicing an avocado? And what happens when it goes wrong? The knife strikes the large, hard, slippery seed in the middle and the blade glances away and stabs or slices the other hand.

It happens more often than you think. The kitchen is one of the most dangerous places for a hand.

Canberra's medical staff report that the avocado - green, firm and innocuous-looking - is the food most likely to send a woman - usually it's women who find themselves in this situation - to the emergency department with severed tendons.

Pumpkins come next.

For women who think this fact is depressing in the year 2012 - females spending a lot of time in the kitchen and all that - there is a consolation. Sort of.

Back at the hospital, Ying says most females she sees who have injured their hands have not done it in the kitchen. Most did it playing sport. Plus she is seeing more and more women nursing ''punch injuries''.

This is where a person punches something, or someone, and, usually, fractures a bone in their pinkie finger.

The unit Ying works in has operated on 16 punch injuries in the last month for men and women, meaning the hospital does about 160 of these surgeries a year. Only about half of all punch injuries need an operation.

''Women don't get involved in fights but they'll punch objects. Often they'll say I had a verbal fight and then punched the floor, or a wall or the fridge,'' Ying says.

For Ying, she will always like the cutting and the fixing.

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