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The many-surgeon team agreed that the most urgent job was to restore the arm's circulation. Specialists in blood-vessel repair first made sure the blood would have a way to get out. With neat and delicate sutures, they stitched the arm's two main veins to their extensions in Ev's shoulder (see diagram). Next, they opened a way for the blood to get in by rejoining the major (brachial) artery. Says Dr. Shaw: "When we took off the clamps from the artery above the break, we rejoiced at the pinking up of the arm as the blood ran through it." It was just 3½ hours since Ev Knowles's arm had been severed.
Single Stitches. Lying on the operating table beside its owner, the arm was still attached only by suture threads. To fix it firmly, an orthopedic surgeon drove a stainless-steel rod into the broken upper end of the humerus, through its squishy marrow center, until the end of the rod projected into the shoulder. He fitted the broken bone ends together, pushing the rod down into the marrow of the undamaged lower bone. If new bone grows well enough to make a solid union, the rod may later be withdrawn; otherwise it will be left in place.
The most delicate and difficult part of such restoration surgery is to rejoin the nerves so that they will resume their task of controlling the muscles. Neurosurgeons usually prefer to wait for weeks or months after the original operation before they attempt the job. The M.G.H. surgeons identified the three main nerve bundles in Ev Knowles's shoulder and arm, drew them together, and rejoined each with a single dacron stitch—a holding operation so that the nerves will not shrink.
Only after all this, which took four hours, did the plastic surgeons get around to what they usually do first: guard against gangrene by clearing both sides of the wound site of all tissue, mostly muscle, that is crushed or deprived of its blood supply. In this case, they delayed because it was more urgent to restore the circulation promptly. At last, they stitched together four major muscles and as much skin as was left around the fracture. It was not enough, but the rest of that job had to wait.
For Ev Knowles also had some injuries to his left hand. The surgeons encased the boy's trunk and right arm in a cast that held the arm in a bent position, as though to ward off a blow. Still anesthetized, the boy was wheeled to a second operating theater. There, surgeons straightened out his battered left hand and sewed up its skin wounds. Ev Knowles received four more pints of blood during the multiple operations, which lasted eight hours.
Exercise the Right. Within two days, the sturdy young patient was taking regular meals. He now feeds himself with his left hand. After five days, his temperature was normal, and the wound showed no sign of infection. But this meant no respite. Last week the plastic surgeons took Ev back to the operating room, pared big patches of half-thickness skin from his right thigh, and grafted the patches onto the raw areas near his armpit.