18
10
A father whose hand was sewn into his stomach in a groundbreaking procedure has revealed the harrowing stages of his year-long recovery - and said he hopes to one day have fingers again.
Brazilian Carlos Mariotti feared his hand would have to be amputated after a horrific workplace accident, but has spoken proudly about how he has once again mastered tasks he previously took for granted.
In a world exclusive interview with MailOnline, Carlos revealed how he can hold his toothbrush and talk on his mobile phone, things he thought he would never do again.
It's taken months of practice to do this simple task but it's a milestone achievement in his recovery.
That's because Carlos's left hand is shaped like a boxing glove with a tiny thumb and a ball of puffy flesh where his four fingers should be.
Small remnants of the bony digits are tucked inside his fist-shaped stump, which is covered on the back with skin taken from his belly and on the palm with skin grafted from his thigh.
The orb-shaped mitt is the result of three pioneering procedures by Brazilian surgeons to save Carlos's hand from amputation.
And it's not over. He is facing another ground-breaking operation as doctors prepare to cut and reconstruct his hand into individual fingers.
It will be the first operation of its kind in the world with physicians hoping to restore some functions and sensitivity to the shattered parts.
It's been a harrowing journey of recovery for the former machine operator from Sao Ludgero, south Brazil, following the grisly accident in March last year.
Carlos's hand was ripped to shreds after it was trapped between two coil rollers in an industrial machine used to make plastic cups and plates.
'I remember the machine had some problems. We had to switch it off and start it again,' the 43-year-old recalled.
'We were putting a roll of film into three different coil cylinders. I don't know whether it was the fault of the machine or a problem with the other operator, but as we put in the film, the machine started to pull my hand in.
'I screamed in agony as my hand was dragged into the machine. I got the strength to wrench it out but as I did, I lost all the skin on the palm and the back of my hand.
'I lost all the nerves and veins and the tops of two of my fingers. It was totally mutilated.'
The accident destroyed tissue, severed blood supply and left bones and tendons exposed before his workmates could rush over to help.
'I was in unbearable pain and was told at the hospital my hand may have to be amputated,' remembered Carlos.
'But I had a lot of faith that this wouldn't happen, and God would put someone there to save it.'
Dr Boris Brandao, orthopaedic surgeon at Santa Otilia Foundation Hospital in Orleans, was responsible for making the ingenious surgical decision to salvage Carlos's degloved hand.
He inserted it inside a soft tissue pocket in the injured man's belly so the flesh from his stomach would, over time, fuse with the back of the hand and cover it.
Brandao took the amazing picture of Carlos lying on the operating table with his mangled limb tucked inside the body pouch. And he photographed him with bandages wrapped around his midriff which were protecting the buried hand.
The physician's remarkable intervention gave the factory worker a fighting chance to get his hand back.
Brandao revealed: 'I had never done this procedure before but I knew what was possible. We separated the skin from the abdominal muscles and created a bag inside his body.
'I inserted the patient's hand through a 10-centimetre incision into a cavity in the abdomen. This prevented infection and necrosis from setting in, while allowing the limb to reconnect to blood supply and restore muscle and tissue.'
The surgeon, who is also a dermatologist, continued: 'We sutured and sewed it into the abdomen so the skin would cover the back of the hand while the muscle beneath would form the palm.'
Carlos kept his hand buried in his belly for 42 days.
'It was a really weird sensation because I could feel my fingers wiggling inside my body,' said the married father-of-one.
'When I moved them around my tummy protruded as I prodded about. I was told by doctors to make sure I kept my hand pushed inwards and to keep my fingers moving so they didn't seize up.
'Every day I reminded myself that I couldn't take my hand out because it was in a pocket. I was terrified I'd break the stitches and damage my chances of recovery.'
Carlos experienced 'terrible pain and discomfort' during the time his hand was pinned inside his tummy.
'The pain was unforgettable and unbearable. I struggled to sleep because I couldn't turn on my side or lie on my front,' he said grimacing with the memory.
'Sometimes, I would explode with rage because I was so frustrated with being helpless. I was dependent on other people, particularly my wife, Cida, who was incredibly patient, to help me with my personal hygiene, change my clothes, button up my shirt and put on my trousers.'
In May last year, six weeks after the first surgery, physicians removed Carlos's hand from his paunch with the skin of his abdomen successfully covering the back.
The front of his damaged mitt however, was an unsightly mass of bloodied flesh cut from his midsection. This is the muscle and tissue that has been used to rebuild his hand into its present form.
During surgery, physicians separated the thumb from the rest of the hand with an incision, then woke Carlos up and asked him to move the limb which was unrecognisable as a hand.
Despite this, the determined patient flexed and moved the fingers as the joints inside the mass of brawn responded to his command.
Carlos, who has been with his wife Cida, 50, for 17 years revealed: 'The doctor said lift up your hand, move it around and try to do some movements.
'He put a piece of paper between my thumb and my hand and I grabbed it. I remember he tried to pull it and it wouldn't come out.'
The third procedure, seven days later, involved splicing skin from Carlos's left thigh and grafting it onto his palm.
Unfortunately, areas of the transplant died within a few days and sections of the damaged skin had to be cut out from the palm.
As the hand has healed and taken the shape of a boxing mitt, physiotherapy has aided Carlos's recovery. He can scrunch it forward to hold his mobile phone and uses the thumb in a pincer movement to grasp his toothbrush, grip a pen and clutch a knife.
But he hates wiggling the remnants of the bones of his fingers inside the fist.
'I can feel the small pieces of my fingers moving around and sometimes the points of the bones jab inside and hurt,' he said adding that now he is able to do much more than before.
'Today I can put on my socks, put on my t-shirt and take it off, change my shorts and slowly do up the buttons on my trousers. I can take a shower and cradle the soap in my left hand whereas before it would slip out and fall to the floor.'
But he remains frustrated as he sometimes forgets his injury.
'There are times I go to pick something up but when I reach for it, I can't. Then I remember I don't have my hand anymore and that's a really strange and upsetting feeling,' Carlos admitted.
He's hoping the forthcoming cosmetic surgery will change all of that.
The pioneering procedure will be performed in two stages.
The first operation will divide Carlos's hand into two parts, creating the shape of a vee, with a pair of fingers encased in each of the halved sections.
A deeper cut in the area between the thumb and the hand will improve the thumb's flexibility.
The hand is currently bulky because of the abdominal fatty chunk of skin used to cover the back of it.
Liposuction will drain away the fatty tissue improving the look of the hand.
After a few months of recovery, the final procedure will cut into the two separated sections, dividing and reconstructing the digits into four fingers.
But there is no certainty when the procedure will be done as the surgical costs are far beyond Carlos's budget since he is no longer able to work.
In a desperate bid to regain his independence and self-esteem, Carlos has launched a JustGiving fund raising campaign.
'I have been through a lot and struggled to make ends meet since the accident. Much of the surgery has been done with the kindness of Dr Brandao, as my employer has failed to support me,' said Carlos, adding that his eight-year-old son Guilherme was traumatised by the incident and suffered from nightmares for months. These have now receded.
'I never imagined in my wildest dreams that doctors would take this incredible step to save my hand.
'Now I need to complete the journey, rebuild my life and return to work to support my family. But I cannot get to the next stage without help.'
Carlos's employer, Zettapack Industrial de Plasticos, was approached for a comment but declined to respond.