Medics fight to save girl's arm

SEVEN-year-old Megan Pelly was lucky she still had her arm last week after a playground accident left her with no pulse in her left hand for about nine hours.
On May 7 at 1.45pm, Megan fell off the monkey bars at Ohakune Primary School.
"She loves climbing, so it was a huge shock to me," her mother, Jane Pelly, said. "She got brought in to me with her (left) arm hanging down, so we took her straight to the doctor, who said he thought she'd broken her arm."
The GP injected Megan with a painkiller and called an ambulance to take her to Wanganui.
But when the Taihape paramedic arrived from Waiouru at 3pm, he immediately recognised Megan's condition was more serious, she said.
"(He) felt Megan's hand and realised it didn't have a pulse and that it was going cold and blue."
As he was on his own and Megan could not be strapped in or driven over the Parapara, the St John driver called for a helicopter.
"With the blood not coming down, it was urgent she got to hospital as soon as possible," Mrs Pelly said.
By 5pm Megan was at Wanganui Hospital and was rushed into surgery at 5.50pm, beginning a seven-hour wait.
Wanganui Hospital general surgeon Gerhardus Bonnet said a fracture to the humerus bone above Megan's elbow had blocked her brachial artery, decreasing the blood flow to her lower arm.
On arrival her arm was cold and had no pulse and her core body temperature was less than 36 deg C, posing a further risk to the arm because her body could conserve energy by stopping blood flow to her outer limbs.
Orthopaedic surgeon Manjunath Basappa and general surgeon Atul Dhabuwala stabilised the fracture and extracted a vein from near the artery before Dr Bonnet was called in at 8pm to perform a vein graft.
The damage to the artery meant it had to be removed and replaced with a vein to prevent clots from forming on the damaged surface and blocking blood flow, he said.
The tissue ? including the harvested vein ? had been so traumatised that the vascular surgery had taken about three and a-half hours, he said.
The surgeons had had to reverse the procedure and use a different part of the vein before the blood flow returned, he said.
"The main challenge was the size of the artery in a seven-year-old. It was very small ? about a millimetre and a half in diameter," Mr Bonnet said.
The surgeons were concerned that it had taken more than two hours to get Megan to hospital. Delays increased the risk of decreased blood flow to the arm and the potential for loss of the limb.
From the time the artery was blocked, it would have taken about 30 minutes for blood flow to cease. However, it seemed this had been kept going in Megan's case by the fine veins branching into the forearm, he said.
Although there had been a 20 percent risk of amputation, tests had so far shown the nerves of Megan's hand to be fully functional, Mr Bonnet said.
"It's still early days, but as far as we can ascertain at the moment everything is as it should be."
Home after five days in Wanganui Hospital, Megan was "happy" to be back, despite the burden of an extra-heavy arm with three pins in it.
The loss of her arm would have been "devastating" for the outdoor girl.
"She would have found a way to manage, but it would have been devastating," Mrs Pelly said.
Wanganui Hospital staff had been "very, very helpful'' and good to Megan, she said.
"We just want to thank the hospital ? they've given us back a daughter with two arms and that's just incredible to us."