By Levon R. Karamanoukian
STEPANAKERT — Surgeons in the Republic of Artsakh recently performed complex microsurgery to reattach the right arm of a 20-year-old man after a traumatic and life-threatening industrial injury. According to surgeons at the Central Republic Hospital in Stepanakert, Tigran Musayelyan sustained a mechanical avulsion injury that spared his life, but completely amputated his upper right arm, on September 8, 2022. (In medicine, an avulsion injury is one in which a body structure is torn off by either trauma or surgery.)
The patient was transported by the medical transport team, equipped with military life support equipment, in critical condition to the trauma unit where he was immediately evaluated by reconstructive surgeon Dr. Igor Zakaryan, Chief of Plastic and Reconstructive Surgery at Central Republic Hospital.
“A decision was made to perform complex reconstruction and microsurgical reattachment of the upper limb to improve his long-term functional outcome,” said Zakaryan. Organizing a critical care team composed of trauma surgeons, anesthesiologists, orthopedic surgeons, vascular surgeons, and medical specialists, Zakaryan recognized a unique window to salvage the severely mutilated limb and reattach it to the body.
“The decision to perform limb replantation is crucial and time-sensitive; even small delays in timing can mean the difference between success and failure…we were faced with the life-changing decision to restore function to this young man,” added Zakaryan.
Limb replantation requires complex microsurgery. “The chance of success is severely reduced in patients with avulsion rather than sharp cutting injuries to the soft tissue. The actions of Dr. Zakaryan and the trauma team at Central Republic Hospital in Stepanakert are nothing short of spectacular,” said California plastic surgeon Dr. Raffy Karamanoukian, who authored a paper on the feasibility of robotic microsurgery in the Journal of Reconstructive Microsurgery. “Replanting an upper arm in an avulsion injury requires expertise and coordinated trauma protocols that can help resuscitate and stabilize a potentially life-threatening injury.”
