Your limb is torn off - now what?

semitic effects. Yea, you know the mine has an impact on the body. Well, if you can be a hypochondria, actually you can do the officer right, Yeah, yeah, you can will yourself in not being sick. Anyway, people, the show must go on. And I just want to point out how dedicated my partner here is to his craft. Well, I also want to say I want to promise that it's not going to be like the great six weeks on this of No. You know gets that was back

in the old days, the unhealthy days. I smoked and everything. Yeah, your body didn't know how to heal, so it was enjoying nicotine. Now I'm just like I'm I'm not getting sick. I said it to myself last night, and here I am better than you ever Josh two point oh, thank you. All right, let's do this okay, ready, Yeah, I got a story for you. I bet I know it. I'll bet you. Yeah. Yeah. You saw. His name is Everett Knowles Jr. But everybody called him Eddie two days in

a why I find the unwholesome. Yeah, And I didn't know Eddie could be short forever it never heard that. I don't think it is. I think he just didn't like his name, Okay, because it seems like you should call him every Yeah, heavy heavy Evie. Yeah, of the Biggie, the big So he was a little e though he's a little guy, tiny, like a little Elvis. That's right. Uh, well, Eddie, we'll call him Eddie because that's what he preferred to

be called. Sure. He was walking home from school one day in Somerville, Massachusetts, which is a suburb of Boston, and he was walking along the railroad tracks and there just happened to be a train loaded with gravel hauling out of the area very slowly while he was walking alongside and said, you know what, I'm just gonna have a little thrill right now and grab onto this train. And he did. He successfully grabbed onto the train, was

hanging with I believe his right arm. Yeah, and uh was having the time of his life just dangling there when he misjudged the distance between the train side of the train and the side of a tunnel and he was pulled into the tunnel support and smacked it and hung on for a second before he was dropped off of the train. The train kept going through the tunnel, leaving Eddie kind of crumpled and in a little shivering mass at the mouth of the tunnel. So he stands

up and he grabs his arm. He's like, oh, my arm doesn't feel very good. And he starts walking toward town. And apparently he walked about a hundred yards uphill when some workers saw him and said, grab that kid, because he was covered in blood, he was staggering, he looked like he was out of he's clearly in shocks, and

they grabbed it, ran and got a woman. Because at the time, this is nineteen sixty two, a woman was the only one who could provide any kind of initial emergency care um and a clerk at I believe some sort of warehouse um came out and started to apply pressure to this boy's wounds. But she had a little bit of trouble when she tried to close the wound with a tourniquet, she found that his arm wasn't attached to his body any longer, and he's just kind of

holding it there. Very Luckily he was wearing a jacket, or else his arm would have been back at the mouth of the tunnel. Man. Can you imagine, like the guy's holding his arm basically to keep it from falling out of his jacket, although he didn't know that, you know, no, he didn't. He was in shock. Luckily, he was still lucid enough to like tell everybody who he was, where he lived, and uh. They called the the hospital, and

the hospital scrambled some surgeons. But it wasn't until chuck um he got to the hospital and they started cutting his jacket off that they realized the extent of the damage. This kid's arm was torn clean off. But the operative word is clean, yeah, right. Because Eddie Everett Noels Jr. Of Somerville, mass On what May two became the first recipient of a full successful limb reattachments, first human recipient. Yeah,

it's a good point. They had done that before dogs successfully, and they had they had done all the different surgeries that are required to reattach a limb, but they had never done all of them at once, like they'd reattach the nerves, they'd reattach bone, they've reattached blood vessels, but they had never had a full amputation and a human being successfully reattached. And um. From what I read, the doctor was I don't know about excited, but they had

been looking for a case. I was because they thought, like, I think we can do this. We just need the right case right exactly, you know. And he called his buddy and he's like, I think we got one. Getting there, they got the They like you said, they'd successfully reattached artery's nerves, bone, that kind of thing, but never all, never the whole shebang. So they said, well, we know how to do this if somebody will just come along and present us with an arm pulled cleanly off, especially

twelve year old, because that definitely worked at his advantage. Apparently, an artery when severed will plug itself up, especially in younger kids that plugging is way more successful and happens more quickly. So this kid just basically presented like the perfect case. The main artery, I guess his brachial artery leading out of his shoulder was a full like two inches out of the wounds. So like they had a lot to work with, and work they did. Uh. Yeah, and they the arm was on ice and they began

working immediately. This is mass general, by the way, and um. They started with the arteries and veins, and then the nurse felt well, they all sort of sold color and they described as a glow kind of came back into the arm. This kid hopped the train, had his arm pulled up, and within two and a half hours they had gotten circulation back. Yeah. And the nurse scrabbed the hand and said, hey, it's warm. That's good thinking warm. She shook it, made it do the metal sign. Everybody

in the operating theories laughing. Uh. The bone and the muscle and the nerve and the skin. Um happened in in later surgeries, and the I think the nerve. They made a pretty important decision at the time was to wait on that altogether, uh, and let it heal some more first, which is as it turns out, actually, as it turns out, most of this was sort of how they do it today, Like they perfected the process from that point through the seventies and in the eighties is

when they really started like humming with limb reattachment. The only difference that I saw was and we'll get into it a little more, but um. They reattached the arteries first to get circulation, I guess, to keep from more and more tissue dying. Um. And then they reattached the bone by driving a screw and using a hammer. They nailed the screw into the marrow, and then reattached the arm bone. What is that femur? Now? Femurs in the leg? You think I would have looked this up already. Yeah,

the upper arm bone. Then they drove that into the other end of the screw. Normally now though they do they retach the bone for supervide stability, so when you reattach the arteries and veins and stuff, they won't pull away. Yeah, and he uh, it was a success story because he ended up he was uh, he couldn't use that hand as his dominant hand any longer, which just said because

he was a good picture. Yeah, but he um was able to eventually get enough use out of it to where, uh they said about like a left hander would have use of his right hand. So he just sort of had to switch that up. But for nineteen two that's pretty successful, especially considering in nineteen sixty was the very first microsurgery performed just two years previously at the University of Vermont. Oh yeah, go catamounts. But um, so microsurgery,

that's really what we're talking about here. It's the use of a microscope to perform surgery. And when you're attaching, you're essentially sewing together little nerves and blood vessels like a millimeter in diameter. You need a microscope and a tiny, tiny little needle, right, and you're using tiny, tiny little sutra thread, which is about is is is big as a hair. That's the stuff you're using to to suiture

these blood vessels back together. It's not no and it's an extremely involved um surgery, as you can imagine, but it's step by step. It's like, first you do the blood vessels, then you do the arteries um and you do muscles, ligaments, tendons, all this stuff, and you're doing it in this this process, but each each surgery, each part of the procedure is like an enormous surgery in and of itself. So like um, a limbery attachment, which is called um replantation. I thought it was gonna be

called like limbery or something. Some people call it that. I'm a limist, the saucy. Your doctors call it limbery. But um, it usually is like as on a whole. The replantation surgery can last like an entire day. Yeah, it's it's intensive. Um And I read too that it uh the whole micro surgery. The concept of using a microscope for surgery was not accepted at first, Like the doctors and surgeons were like, now, like you, we can't

do that. We have to look with our eyes. And so it had to be perfected sort of on the fringe by doctor by surgeons who are willing to like accept this might be the future and experiment in their basements. I guess so on hapless victim maybe or dogs. Yeah, I didn't get the and I didn't look it up, but I didn't get the impression from this article one way or the other how dogs lost their limbs to begin with, Like, was it accidental? And they're like, Okay,

well this we'll reattach it. Or were they cutting dogs limbs off and then reattaching them, because I'm guessing it was probably the latter in it. Probably Yeah, I mean we've talked plenty about that kind of topic, because I mean, think about it. Why would dogs limbs be pulled off in any more frequency than humans limbs and hence present more cases to practice on. I think they were cutting off dogs limbs and then reattaching, which is messed up. Yeah,

it is. So you were talking about microsurgery. What I saw was replacing toes for thumbs got big sixties. That was a big one. So you had a thumb on your foot or a big toe on your hands, big toe on your hand, because apparently fifty to sevent of all the utility in your hand is in your thumb, and if you're missing a thumb, you might as well just not have your hand. You don't need a big toe quite as much. You can use a cane or something like that thanks to your new toe thumb and

um that that became perfected in the sixties toethumb. That's a good band name. And then uh in the seventies, um free flat tissue transfer became a big thing, which is basically going to a part of your body, harvesting an area of your body like under your thigh, your abdomen um I think you're back, lower back, and then

just basically taking the gap and sewing it back together. Right. Yeah, so you have a scar, but you also have a portion of your body that's diminished in size um, and then taking that and using it to basically do what we understand is a skin graft, which which requires microsurgery as well. Um, it's just basically taking this part here and putting it back over here where there's a bunch of damage and reattaching all of the nerves and the

blood vessels and everything. Yeah, I saw when I was looking up photos of this kind of thing, I came across something that I had never seen before. And I didn't I didn't get the story, but you could almost. I mean I sort of gathered what was going on

just from the photo series. But someone was degloved on the on their fingers basically from like the hand knuckles forward, all the fingers had no skin, and they, from the looks of it, they inserted it into an arm like into a bicep the fingers and like they live there for a while, like inserted under the skin of the arm, and that that skin. They later would remove the fingers and it came off as like a big flat skin graph like sticking your hand in an envelope and uh,

eventually formed like webbed fingers and then fingers. That is crazy, but like, I don't know, man, I just saw these photos. I should have done. I mean, it doesn't really have anything do with this, but it was just remarkable. They see someone with their fingers stuck in their bicep under the skin. Like, I'm having trouble visualizing this. I need to see these photos. Yeah, I'll take about the show out to you. Yeah, if you want to see some

really gross stuff, you can just google. Um. Microsurgery or replantation is another one. Yeah. Man, it's but amazing like that they can. And I looked at so many of them. I kind of got to that point where I was like, well, this isn't gross. This is what the body looks like without skin sometimes, and which is gross. Nuts. I wouldn't grossed out bodies without skin or gross, I don't think so.

I think it's the beauty inside you couldn't desensitize my friend. Well, before we get any further, Chuck, let's do a message break, because I got some good stuff coming up. So Chuck, we understand microsearcherry. Now it's frankensteiny in right. Yeah, you're basically just sewing stuff together. Yeah, because I mean, like, let's say you have a dead person who has a great hand, and you have a live person who's got

a poor hand. You cut off the live person's hand, cut off the dead person's hand and attached the live or the dead person's hand and a live person. That's that's Frankenstein and that's what they're doing. And it's pretty cool. Um, But if this ever happens to you, if if say, you have a poor hand in that it's no longer attached to your wrist, han sucks, right, and it's all crushed and damaged or whatever. No, no, no, let's say

it's intact. And you say, you know what, I think through my shock that I might be a good candidate for replantation of my hand. Yeah, what do you do? Well, you want to call mine one one immediately, because that's just the first thing you do. You get go ahead and get folks on the way, or you can ask someone with you to call nine one one. That's not putting anyone out. Yeah, that's true. If you can't dial, maybe you don't have hands, you can tell Sirie to

call nine one one. Yeah. I actually changed my series to a dude, so it's not a her anymore, but an englishman actually. Yeah, it's kind of fun, Reginald. I don't know what his name is actually, but he'll say stuff like, you know, I'll say call Josh and we'll say ringing Josh. Oh yeah, instead of calling it. It's classy kind of fun anyway. Um, you want to dial mine one one, get them on the way, and then immediately you want to just try and stabilize the patient.

You want to stop the bleeding, either with heavy pressure or a tourniquet above the wound like a sixties female. Yeah exactly. Uh. And once you get the patient, UM, stabilize and they're not going to bleed out there in the kitchen or wherever it is. Um, you want to get the digit or the hand or the limb and put it on ice, but not directly on ice. Put

it in a bag and then put that bag on ice. Yeah, you want to pack pack it in ice, as much ice as you can find, but you want to make sure that in the bag that you put the hand or the digit or whatever in there's no ice and there's no water, because water causes it to shrivel, and that means you won't be able to reattach it. Yeah, and ice you can actually if I put if I cut off my finger and I threw it in a bucket of ice, it could actually get frostbite. Yeah, that's crazy,

That is crazy, but it's also pretty cool. And you don't want frostbite on your because you know you won't be able to use it anymore. Now. Frostbite is just um dead tissue brought about by exposure to extreme cold. That's right. So after the T shirt right there is after you've got it on the ice, in the bag, on the ice, you've call nine one one, you've got

the bleeding stopped. You want to cross whatever fingers you have remaining and hope that you've got a good hospital nearby with some surgeons that aren't doing much at the moment, or who are willing to cancel their schedules and say let's go do this. Yeah, get off the golf course. So when you get to the hospital, there's some things you can expect. If all of your surgeons have come in from the golf course, they should be ready and

waiting for you. And um, like we said, first they're going to reattach the bone to provide stability um for the rest of the surgery. And there's probably still going to be a little bit of a gap there because they need to get in there. Um. And then they start reattaching your your blood vessels. And just like with Eddie Knowles, um, that just gets you know, the blood flow going and essentially makes that limb alive once more well,

and it also keeps it from further dying. Um, because Chuck, it turns out that like there is a a finite amount of time, which is understandable, but we we are aware of how much time a limb can just sit around in the hot sun starting to go you know,

fit it. And there's so for example, um, if you have a whole arm or a whole leg cut off, remember death Proof, Yeah, that girl has her legs like sticking out of the window and mad Mike is that his name Russell when he hits him and her legs goes Um, if she had survived and her leg just laid there out at room temperature, Um, it could have been good for six to twelve hours. I imagine you're

really pushing it at twelve hours. But if say you have somebody who's like this leg needs to be put on ice and does everything right, it could stay refrigerated for four days and still be reattached. Yeah. Um. They point out though in this article, ideally you're having that surgery that day, but if you within hours, uh, within minutes, they're talking. Ideally, Basically, the sooner the better. It's as soon as they're ready to go, you should be ready

to go as well. But you're right, Um, if that is not the case and you have uh some good refrigeration going on, you can last for about four days. Yeah. And apparently it's not even necessarily the skin tissue that um that leads to problems and reattachment after being exposed or room temperature. It's muscle degradation. Oh yeah, interesting. Uh,

So you you get there, you're getting your surgery done. Um, you probably are going to expect to go through that first long surgery phone reattachment, blood vessel, maybe some muscle fiber and then sure, and then they'll say we'll put the nerves off for later. Um, and then later on down the road will be a skin graft of some kind, like a UM free flap surgery like I was talking about. And the free uh refers to the the free like this part of this issue from your body has been

removed the donor site. Oh, it's not the cost of the surgery, it's it's been cut free, right, And then you have makes sense and then um, it really is simpler than you think. It's reattaching, and hopefully everything takes and you fight the infection off and you start the rehab process, which um, it takes a long time, and it's it's grueling and not fun. Uh. It can be weird at first, uh, they point out in the article, And be weird to look down and see your army attached.

But I imagine no weirder than looking down and seeing your arm not attached. You know, it'd probably be a comfort to see it reattached, But you're a jerk if you're like, oh, it's kind of crooked. Yeah, but apparently sometimes it can feel a little different, and uh, that can be a little strange and off putting. It's not like, oh, I'm just like I was before, right, you know, better than ever? Um and Tom wrote this one my good friend time chief. He said. He also talked about something

called cross transfer. This was mind blowing, which is basically like if if just re plantation is Frankensteinian, this is even more so. Yeah, I didn't quite get the purpose of the hand. Uh, Basically, you're getting a a left hand on your right arm. Let's say, so your thumb and your pinkie would be in weird places, right, your palms still facing the right direction, but switched. Yeah, yeah, but what's what's the point of that if you have

a bad hand and a good hand. I don't know if that's they only had like a left hand available at the time. I don't know that one. I got the other one where basically they take your lower leg beneath your knee. So like if your upper leg is damaged and your lower leg is fine, let's just say your upper leg is wasted for whatever reason, but your lower leg is fine. They'll cut it off the lower leg and basically turn it around right, and then your

knee becomes locked. Your calf muscles then serve the function that your thigh muscles used to and your knee joint is now in your ankle, then you also are going to be wearing a prosthetic obviously because you have no thime muscles um, and you're turned around foot which is now backwards. Is extra support for that prosthetic foot or leg or limb? Wow, it's pretty cool. It's basically saying like, how can we take this and use it to even

better utility now that its original purpose has been destroyed? Yeah, it's pretty cool. Yeah. I tried to find photos of a cross transferred hand, but I couldn't find any photos, and weirdly, pictures of Madonna kept popping up. Does she have something? I don't know, dude, Like I tried all sorts of Google searches and she images of work kept popping up, So I don't know. Maybe she's got two left feet or something. She does not? What was that in uh Waiting for Guffman? Uh? He literally had two

left feet. It's kind of a dumb joke, wasn't I thought it was? Yeah, So, Josh, that's one way we talked about microsurgery. But there's perhaps another even better way which will cover right after this message break. All right, so we've discussed how you can have surgery, but there may be an actual way to regrow things. Yeah, this is far, by far the more prefable of the two. Yeah, like fingers, but not like you know, you can't lose a whole finger and regrow. It's got to be above

the bone. Like let's say you get the tip of your finger, like your fingernail cut off and you can't find it. And even better, this just involves like dumping a magic powder on that that wound. So if you if you have your finger cut off below the nail, right below the nail, which happened to a guy in Cincinnati, um in two thousand and five who owned a hobby op. Yeah. I used to love those places. Man, I go in and be like, I just want all the model airplanes

and everything. Yeah, Eddie's Trick Shop in Atlanta was my go to, which I've just discovered still exists, um, not too far from my house. Is it a magic shop? It's it's like everything, Like they had models and had magic kits, they had you know, Whoopie cushions was sort of like a catch all. Yeah. I liked both of those, but I never went to one that was the same anyway. Um, this guy, this hobby shop owner, as far as we know, he sold no magic items. Um, he was demonstrating why

a motor was very dangerous in an RC plane. He did a good job, I guess, and cut his finger off and uh, apparently his brother was had something to do with finger with tissue regeneration and said he was in the biz. Yeah. The guy went to the doctor the hospital, and doctors like, we'll give you a skin graft to just kind of cover this weirdness. But um, you know, you lost your finger. T s. And the guy's brother was like, don't get the skin grap just yet.

Come over, I'll give you a beer, and um, I'm gonna put some I'm gonna put some something that's called extracellular matrix on your wound and let's see what happens. And they did yea, and magic happened. Then it regrew. The guy not only regrew his finger, he regrew apparently not the bone, but very surprisingly the nail bed and fingernail, which apparently, like you don't grow a nail bed back, like even if you cut off just the tip of your finger like that nail beds never growing back. This

guy's nail bed grow back. That's awesome. Extracellular matrix is awesome. Um. That's basically like the glue that holds ourselves together. And um, not just us, plants and animals and trees and they all have it uh in it. Uh, it's functions outside the body cells. That's why it's called extra cellular obviously. And it's collagen. We talked a lot about collagen, the protein that's um, you know, super good for all kinds of things, especially Yeah, like you know it's in skin

cream and stuff like that. Um. So typically what they use is, uh, this was a powder from pig bladder. But um, I've seen I saw a video on the New York Times site that showed how they do it today. And this is mainly for um like, uh, let's say you got you didn't want a skin graft for some reason, or it wasn't possible to get a skin graft, and you've you've lost all the skin on your thigh. It would get a pig bladder and they they spread it

out and they remove all the cells. Basically, Yeah, because this stuff doesn't have pig cells, No, it doesn't have just harvested from a pig body. Yeah, but they still remove the cells and all the DNA with like a chemical bath, and basically what's remaining is the matrix. And it ended up drying it out and it looks like and cut it into she and it looks like a sheet of like parchment paper and then they will put that on your leg and it immediately just starts going

to work. Yeah. They used to think that extracellular matrix was just something that provided structure for cells to grow around, like a fetal in the fetus. Yeah, because if you're if you're in the fetus and like something happens, you lose a toe. If you are a fetus, if you're in the fetal position, uh, in the womb and you lose a toe, that toes growing back. Yeah, you know, you grow a vestigial tail that goes away. Your feet and hands start out being web so you're growing a

lot of stuff and then getting rid of it. But you can also regrows stuff that you're not supposed to lose up to the age of about two, and then I think the general ideas that the extra cebular matrix just kind of goes dormant in humans, right, but they thought that it was just structure, and then they realize that no, this is actually creating some sort of signal to the rest of the body to say, hey, don't scar regrow instead, and it goes and recruits stem cells

and says, come over here, and let's rebuild this finger. This hobby shop accident was too ironic. Let's reward this man with a regrum finger, and don't forget the nail bed. That's what ex cell your matrix says to everything else. Yeah,

and it's uh, it's pretty cool. The problem with um, why you can't normally just regrow a finger is because when something like that happens, the trauma happens, your body says it recognizes it, and the immune system kicks in and it's gonna swell up and get inflamed and scar tissue is gonna start to form, and extra cellular matrix prevents the inflammation, prevents scar tissue from forming and basically tells the body like, no, I'm just gonna grow like

normally r scar tissue, just regular old cells. But like you said, after a certain age, it just goes away, like we have the extra cellular matrix still, but it's function or its ability to trigger regrowth is just becomes dormant or something happens to it. And with this pick ladder stuff, um, they're they're starting to wonder, is there a way that we can just trigger this naturally in the body. And if that's the case, then say hello

to regrowing a whole head. I mean, you never know, because they pointed out that like deer can regrow antlers and um, things like that, and they're so different than us sellar cellularly right because as bone, cartilage, skin, um, all those things are in your hand, your arm, your leg, and you would need to regrow all those two for something to really be considered regrown. You can't just regrow the leg but not the bone. It'd still be impressive,

but you're like, it's kind of flopped in there. Have you ever seen the picture that UFC fighter. He's like kicking the guy and he breaks his own leg and it's just like almost like a cartoon or mcgahey, Oh yeah, well it's mcgahey. Yeah. Yeah, that's stuff. Um triggers the old mirror neurons big time. Makes me weak. Uh So that's basically it. I mean, they they've been experimenting with war veterans, Iraqi war veterans. Uh. And actually the New York Times video, I saw that it was a war

veteran who was having this done to his thigh. Yeah right, I think it was skin and tendons and yeah, and it was you know, it looked at an early but it was functioning and that counts. You got anything else? No, I think that's it. There's literally nothing else to say about I agree, sir. All right. Uh well, then if you want to learn more about replantation, you can type that word into the search bar how stuff works dot com and it'll bring up a couple of cool things

at the very least. Also, um, type in extracellular matrix, which is pretty cool founding um, and that'll bring up another article too. And uh, since I said those things, it's time for listener. Now, that's right, I'm gonna call this correction. You get these from time to time. We like to read him from time to time. Hey, guys and Jerry love the work you do. I love listening to the show. I wanted to write in though, with

a correction regarding Lewis and Clark. I'm working towards my PhD in art history, and i am particularly interested in the history of medicine and disease. On the middle of the show, Josh mentioned that the adventure party inadvertently discovered syphilis had not been known to Europeans upen to that point. This is actually not quite the case. Syphilis goes back

pretty far in European history. It was first documented in the late fifteenth century after a conflict between France and Italy, and remained an issue for europe peaking around the mid nineteenth century. Nineteenth century. That yeah, he said, okay, Josh did have part of it right though when he said that the part do you blamed it on Native American groups? Early on everyone wanted to blame the disease on everyone else.

No surprises here, But after that initial conflict, the French referred to syphilis as the Neapolitan sickness, while the Italians named it the French sickness, a trend that continued as the stuff spread. You if you're interested, it's really fascinating stuff, especially the cures that became popular. Mercury was a really nasty one. History of Syphilis by Claude Katel is a pretty good reference. He read a book called The History

of Syphilis somebody wrote a book called the History of Syphilis. Anyway, just wanted and that was claude q u e accent of good t e l. He's French. Isn't that what that's called? I don't remember anymore. I don't either. Anybody just wanted to work out. Yeah, that is from Catherine. I'm sorry, Kathleen Pierce nice into disease. Thanks in paintings about disease. I guess so thanks a lot for letting

us know that, Kathleen. I feel like I've been set straight. Uh. If you want to set us straight, we like to be corrected, right, Yeah, and nothing better. Uh. All you have to do is tweet to us to initiate contact. You can tweet to us using our handle s y s K podcast. You can go onto Facebook. That's another great way to contact us. Yeah, you can complain there. Uh. We people love doing that. We're at Facebook dot com slash stuff you should know. You can send us an

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