Case study: Pte Neil McCallion
20 January 2011
On September 4 2006, Private Neil McCallion was involved in a suicide bomb attack in Kabul whilst serving with the Argyll and Sutherland Highlanders in Afghanistan. His Land Rover was blasted on to its side, dragging him along the road. His left hand was shattered and he sustained a shrapnel wound to the head. He was stabilised in a Kabul field hospital and that night he was flown to Selly Oak Hospital, where he went straight into surgery.
Initially, surgeon Garth Titley removed all the damaged bone, tissue and shrapnel from the hand, leaving it empty in preparation for repairing it. There was little textbook guidance on how to treat this kind of wound and, after extensive research, Mr Titley decided to adapt surgery previously carried out in Japan on a foot.
“It’s called a serratus anterior flap with ribs procedure,” he says.
“As far as I’m aware, this has not previously been performed to this extent on a hand.”
The untried and radical approach involved using ribs, muscle and skin from Pte McCallion’s torso to rebuild his hand. Mr Titley put together a surgical team which included three consultant anaesthetists, four assistant surgeons, trauma and theatre nurses. During the 17-hour operation he isolated Pte McCallion’s muscle flap, still attached to the artery and ribs, before plastic microsurgeon Lok-Huei Yap eased each rib away from the lining of the lung. At the same time orthopaedic surgeon Michael Craigen was drilling holes in McCallion’s knuckles for the tiny screws that would anchor titanium plates before binding the ribs to the fingers.
Mr Titley then connected the muscle flap’s vein and artery to the wrist with tiny stitches and finally remove the clamps on the artery with the successful result of circulation returning to Pte McCallion’s hand.
Four weeks after his injury Pte McCallion managed to move a finger for the first time and for five weeks in early 2009 his hand was temporarily attached by a flap of skin to his lower abdomen so that the blood supply could help regenerate skin on the back of his hand. Since then tendons have been removed from his leg and placed in his hand to allow him to straighten his fingers. He has since passed his driving test and is able to perform most of his daily activities.
“When I first saw what had happened to my hand, I really didn’t believe they would be able to save it. Even when I saw the results of the operation, it was a terrible shock. I started crying and shouting that they may as well have taken my hand off. My mum ran out in tears.
“A few weeks later I moved my fingers for the first time: it was amazing, it felt like a huge achievement. I called out to my parents that I’d done it, I was so excited. It was the next step towards recovery and leading a normal life.
“When I learned exactly how the surgeons had been able to repair my hand I couldn’t believe it. It’s almost inconceivable that an operation like that could be carried out. The fact that they worked so hard on finding a solution and put together such a great team with all that expertise really humbles me.
“It’s been a long slog but worth it. I really wouldn’t have wanted to let everyone down after they put all that effort into saving my hand. For me, it means I’ve got a much better future ahead.
“Without this pioneering treatment in Birmingham, I would have lost my hand and part of my arm. Doctors took the decision to do these operations without having done it before. I was guinea pig for this procedure and I am so pleased I was. From now on this type of operation will be more evidence-based and will be able to be translated into other potential procedures.”