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Delicate Surgery and Leeches         Save a Hand

Operation on Stanhope resident a first for Morristown Memorial

By Laura Bruno                                                                                                 April 29, 1999

MORRISTOWN --  Doctors reattached a hand that had been nearly severed in a workplace accident in a first of its kind operation for Morristown Memorial Hospital that included the use of leeches to keep the hand alive after surgery.

Shaun Marinaro, 38, of Stanhope checked out of Morristown Memorial yesterday after undergoing an 8-hour reconstruction operation on his right hand and follow-up treatment that included leeches used to remove blood that wasn't properly circulating, plastic surgeon Daniel J. Pyo said.

Dr. Abram Kirschenbaum, left, and Dr. Daniel J. Pyo change the bandages on Shaun Marinaro's hand.  The doctors reattached the hand at Morristown Memorial Hospital after Marinaro suffered an injury at work.

Though doctors at Morristown Memorial had reattached individual fingers before, Marinaro's case was the first time a full hand had been saved there, hospital officials said.

On April 12, Marinaro was brought to the hospital around 9:30pm after his hand had gotten caught in machinery at Package Development in Rockaway, a plastic molding plant. 

Pyo and hand surgeon Abram Kirschenbaum were called to evaluate the extent of the injury and they decided there was a good chance of keeping the hand alive and eventually having its function restored.

Because the hand was still partially attached, the doctors only had four to six hours before the hand would die, Pyo said.  In the case of a severed finger, there is more time to evaluate the situation since the digit can be kept on ice.  With some blood lines still connected in Marinaro's hand, they had to get started as quickly as possible.

About two hours had passed before they even saw Marinaro and another two had gone by after they cleaned the injury.

Though a lot of times a patient with this type of injury is sent to Newark or New York, if Marinaro had been transferred to another hospital the extra time probably would have cost him his hand, Pyo said.

Watching her husband dutifully wiggle his pinky and ring finger for them yesterday, Linn Marinaro was certain they made the right decision to keep him there.

"It's the most wonderful thing I've ever seen," she said.

Using a microscope to magnify blood vessels by 250 to 300 times, they used suture finer than a human hair to reconnect the arteries and palced two plates and an innumerable amount of screws to fix the bones in the forearm and wrist, Kirschenbaum said.

The leeches were brought in five days after the surgery as Marinaro's hand had swelled up with blood that wasn't circulating properly.  While his repaired arteries were pumping blood to his hand, his veins weren't carrying the blood back out to his heart.

"Without the leeches, his hand probably would have died," Pyo said.

Every four t six hours, two lecches would be placed on his hand and they would suck out the blood, gorging themselves until they dropped off on their own.

"I thought the leeches were gross at first," Linn Marinaro said, "but it really was cool watching them go to work."

While the use of leeches sounds mideval, over the past decade doctors have rediscovered their usefulness.  Leeches were used in medical practice as far back as 1000 B.C., but they fell out of favor in the mid-1800s.

Not only do they relieve the blood flow, their saliva thins the blood in the wound which stalls the clotting process.  This way, even once the leech drops from the wound, blood continues to drain out of the small puncture wound it created, Pyo said.

Aside from having blood sucking creatures on his hand for several days, Marinaro also had to withstand 85 degree climate control in his room.  By keeping his body warm, it allowed for better circulation to his extremities, Kirschenbaum said.

Both doctors said they expect Marinaro to be able to move his wrist and fingers eventually, but he'll have at least eight months of intensive therapy.

Despite all the hard work ahead, Marinaro's wife said she thinks they're going to enjoy this year together.  The Marinaros also have a 5-year-old son, Shaun Patrick.

"We get to do this as a family," she said.  "We're going to recover the family values you lose in the hustle and bustle of everyday working."

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