Severed arm reattached after two hours – An extraordinary achievement by Surgeon Muhammad Ali Shah

In 1975, the editor of Science Digest, Ahmad Saeed Qureshi, sustained severe injuries in a traffic accident and fell unconscious. After spending 32 days in the hospital, he regained consciousness and discovered that one of the bones in his leg had also been fractured. This injury had gone unnoticed due to the prolonged period of unconsciousness. The medical team had focused entirely on reviving him, although a comprehensive examination of his body should have been conducted. A patient who is unconscious cannot indicate where else they may have been injured.

Although Qureshi regained consciousness after 23 days, he was left with a disability in one leg. Owing to his disposition and journalistic background, he maintained a wide social circle. He was a regular member of the Karachi Press Club and attended frequently. At that time, the government in Pakistan was led by Zulfikar Ali Bhutto and the Pakistan People’s Party, with whom Qureshi held strong political differences. Friends and colleagues advised him that, as a journalist, he could easily receive government-sponsored treatment abroad. However, due to his principled nature and deep sense of self-respect, he was unwilling to accept any assistance from the Peoples Party.

When General Zia-ul-Haq came to power in 1977, another principle took precedence. Qureshi was not prepared to be indebted to an unelected, undemocratic, and authoritarian regime. As a result, the matter remained unresolved. His father, Muhammad Saeed Qureshi, was not in a financial position to bear the high cost of overseas medical treatment.

In 1980, it came to light that a young Pakistani doctor and surgeon, Muhammad Ali Shah, had returned to Pakistan after receiving advanced education and training in orthopedics abroad. He was capable of performing complex and delicate bone and joint surgeries that had previously only been possible outside the country. This development signaled that Pakistan no longer required reliance on foreign institutions for the most intricate orthopedic procedures. Surgeon Shah undertook Qureshi’s treatment, and he eventually regained the ability to walk almost without support.

However, due to the long passage of time and the psychological impact of perceiving himself as disabled, Ahmad Saeed Qureshi was never able to fully restore his confidence, even up until his passing in 1994.

Since 1980, over the past sixteen years, Surgeon Shah has performed and treated countless bone and joint operations. Today, in Pakistan, the name of Surgeon Muhammad Ali Shah has become inseparable from orthopedic surgery and the AO Clinic. Recently, while the entire nation was gripped by World Cup fever, Surgeon Shah performed two or three remarkable surgeries that drew global attention. This is Surgeon Shah’s second interview being published in Science Digest within that context. His first interview was published in the May–June 1989 issue.

Question:
For how long have you been providing medical services to sportspersons and athletes, and what is the nature of these services?

Answer:
As you may know, I returned to Pakistan from England in 1980. Around that time, I became affiliated with the Pakistan Cricket Board, and since then, I have been treating injuries sustained by Pakistan’s leading cricketers and sports personalities. In addition to local athletes, I also provide medical care and treatment to foreign players and athletes from various sports. Especially during Test matches or One-Day Internationals held in Karachi, I have consistently served as the Chairman of the Medical Board. This association has continued for the past fifteen to sixteen years. My services extend beyond cricket to include athletes involved in football, hockey, squash, and table tennis.

Question:
Sports medicine and sports engineering are internationally recognized as distinct and specialized fields. Could you elaborate on the nature of these disciplines and the expertise they require?

Answer:
Sports medicine, or sports engineering, is a completely distinct branch of medical science. It focuses on the treatment and care of athletes who suffer injuries during play or face issues related to physical fitness. Athletes are physiologically different from ordinary individuals—they tend to be physically stronger and possess more resilient muscular and nervous systems. Their muscles and tissues are generally tougher and more developed than those of a typical person.

In other words, an athlete is functionally and physiologically unique, particularly because they must perform at a higher level than the average person. As a result, their demands and requirements are also different. Due to these factors, their fitness standards are significantly higher and more stringent.
Even in the case of minor injuries, our aim is to restore the athlete not just to full recovery, but to a condition that is equal to—or even better than—before, ensuring no decline in their previous performance. In this regard, time is of the essence. We must ensure their recovery in the shortest possible period, especially when an important match or event is approaching.
Put simply, sports medicine is the field of medical science that deals specifically with the treatment, care, and rehabilitation of athletes and all individuals associated with sports.

Question:
How would you evaluate the standard and performance of the services you and your colleagues provide in this specialized field from the perspective of developed countries?

Answer:
In the field of sports medicine, two roles hold particular importance: the doctor and the associate physiotherapist. As far as the doctor’s competence, capability, and expertise are concerned, our physicians are no less qualified. Test cricketer Zaheer Abbas has been one of my patients. When squash legend Jahangir Khan was actively playing and faced fitness issues, he would always visit my AO Clinic. I administered injections to him on several occasions. Likewise, table tennis players such as Arif Nakhuda, Naz Shakoor, Seema Shakoor, and Rubina Shakoor, and hockey players like Samiullah, Kaleemullah, Munawwar-uz-Zaman, and Qazi Mohibullah have all been among my patients.

Question:
Would you like to share any suggestions regarding the field of sports medicine?

Answer:
The field of sports medicine should be established in every major city and hospital in Pakistan, and structured courses in sports medicine should be introduced. Although a few courses exist here, they are neither systematic nor of a high standard. The most crucial aspect of this field is that our physiotherapists should be sent abroad for advanced training and specialization—preferably to countries like England and Germany. Upon their return, Pakistan would have its own experienced and well-trained physiotherapists, eliminating the need to spend foreign exchange on bringing in overseas experts.

Currently, we have a physiotherapist from Germany for the cricket team and one from Holland for the hockey team. If we train our own professionals, we would no longer be dependent on foreign experts. These foreign specialists usually come on short-term contracts. When our own physiotherapists return after receiving world-class training, and if they have access to the same equipment and tools they trained with abroad, we won’t have to rely on other countries. Our athletes would then receive the necessary guidance on proper nutrition, caloric needs, and fitness routines. This is the responsibility of a sports physiotherapist—not a surgeon or general physician.

Question:
Banks and financial institutions provide sponsorship for cricket and other sports. Should they not also consider supporting physiotherapy and physical fitness centers?

Answer:
Banks, financial institutions, and organizations like PIA have dedicated sports budgets, but there are no separate allocations for sports medicine or fitness centers. If even a small portion of their focus shifts in this direction, it could fill a significant gap in Pakistan’s sports infrastructure. As I mentioned earlier, our doctors and surgeons are of international calibre, but there is a lack of advanced training and expertise in physiotherapy. When a Pakistani physiotherapist returns from abroad after receiving top-tier training, they can serve the community for years and train others as well.

Regarding the World Cup, it was an excellent opportunity, and I hope Pakistan continues to host such events. Initially, due to the situation in Sri Lanka, the tournament organization faced challenges, but I believe it concluded successfully. Pakistanis, Sri Lankans, and Indians may not be known for strict planning and protocols, but they are hardworking people. Despite difficulties, they manage to organize and execute events with success and energy in the final moments. This time, the World Cup had a significant commercial element, and it was expected that the concluding events and matches would be particularly engaging and thrilling.

As for fielding, South Africa demonstrated exceptional performance in that area. Their strength in sports medicine was clearly evident. Their physiotherapist—a British national and a friend of mine—has visited AO Clinic here in Karachi. He kept his players in excellent physical condition. Their superior fitness enhanced their fielding, batting, and bowling capabilities. The truth is, One-Day cricket heavily depends on fielding and physical fitness. The team that wins in One-Day cricket is the one with the strongest fielding—or, in other words, the best physical fitness.

Question:
Leaving aside the World Cup for a moment, let us now talk about your specialized field—orthopedic surgery. While you are generally known for accepting unique and complex cases as challenges, it has been learned that you recently handled some extraordinary cases that may be considered astonishing and unbelievable even within the realm of medical science.

Answer:
The world of orthopedic surgery is indeed a strange and distinct one. In this field, we often encounter situations where individuals, just moments or even seconds earlier, were completely normal, only to be suddenly thrust into an entirely different state. For instance, a motorcyclist riding along the road may have an accident. One minute ago, he was a healthy, normal person—but the next minute, he is lying lifeless. In such cases, the only gap between life and death is sometimes just a single minute. This creates a dramatic situation that is profoundly intense for both the doctor and the patient.

Likewise, some injuries result in massive compound fractures. Such scenarios are alarming not only for the patient and the doctor but also for bystanders. Occasionally, we receive cases where a patient’s hand or foot has been completely severed from the body, with no remaining physical connection. There are only eight surgeons in the entire world who are capable of handling such cases—cases where a completely detached body part can be successfully reattached. You may be surprised to learn that there is not a single surgeon in India, Bangladesh, Sri Lanka, or the entire Middle East who is capable of performing this kind of procedure. Among these eight, two are based in the United States, two in the United Kingdom, one or two in Germany, and one in Japan.

This is an extremely rare and highly specialized type of surgery known as re-implantation surgery. It involves reattaching a severed body part to the body. However, it is not just one surgical procedure—it is, in fact, a combination of several types of surgeries. The critical factor here is time: if the severed part is reattached within one to one-and-a-half hours, the chances of successful reattachment are high; beyond that window, success is unlikely.
The greatest challenge lies in restoring blood circulation between the severed part and the body. Reviving a part that has died due to a lack of blood flow is no simple task. However, by the grace of God, if blood circulation can be reestablished within two to three hours, that “dead” limb can become “alive” again. But for this to happen, preparations for surgery must begin within an hour and a half at most, as restoring blood flow within three hours is critical.

To understand the complexity of this surgery, consider this: once a part is severed, it includes bones, muscle tissue, skin, arteries, veins, and even nerve fibers all of which must be reconnected. Thus, instead of one procedure, it essentially becomes five types of surgeries in one: general surgery, vascular (blood vessel) surgery, neurosurgery (for reconnecting nerves), orthopedic surgery (for bones), and plastic surgery (to restore skin and appearance). Therefore, any surgeon undertaking such an operation must be an expert in all five disciplines not just proficient, but perfectly skilled—because there is absolutely no margin for error. A minor mistake at any stage can render the entire surgery unsuccessful.

Due to the need for such multifaceted and flawless expertise, there are very few surgeons in the world who can perform these procedures with complete confidence and precision, without even the slightest mistake.

Question:
The four countries you mentioned are among the most developed in the world. Why are there no such surgeons in countries across Asia, Africa, or Latin America?

Answer:
The truth is, when a person becomes highly skilled in a particular branch of surgery, it takes years of intense focus and effort. By the time they master one specialty, they are often mentally and physically exhausted, leaving them with little will or energy to start learning something entirely different—such as neurosurgery, orthopedic surgery, or plastic surgery. Generally, surgeons tend to remain within their area of specialization and do not venture into other branches. Very few individuals possess the ambition and drive to pursue multiple fields of expertise. In other words, once a surgeon achieves proficiency in re-implantation surgery, there remains little else to master—it is considered the Ph.D. of surgery. It is, quite literally, the pinnacle of surgical science. Re-implantation surgery is essentially the distilled essence of all surgical disciplines.

Question:
As far as I know, you perform nine or ten surgeries daily, often involving complex and high-risk cases. After all, you are only human—do you never feel exhausted or overwhelmed? Do you ever regret taking on such a demanding path?

Answer:
During or even before surgery, I do not experience such feelings. But yes, I do get tired—I am made of flesh and blood, just like you. However, I treat every surgery as a challenge, and each case as a mission. I become so deeply immersed in my work that during surgery, I feel no fatigue at all. It’s only after returning home at the end of the day that exhaustion sets in.

While performing a challenging operation, I lose all awareness of myself—who I am, where I am, what I’m doing, or who might be waiting for me at home. My complete attention is focused solely on the case and the patient. I can compare this level of dedication to the experience of Pakistani soldiers during the 1965 war. I’ve met soldiers who, during the 17-day war, did not remove their boots even once. They were so immersed in the battle that they weren’t even aware they were wearing them. When the war ended and they finally removed their boots and socks, the skin of their feet came off with them, having fused with the leather. Just like those soldiers who had taken on a mission, I too, when I accept a challenge, treat it like a form of jihad. In such a mindset, there is no room for fatigue or distraction. And truly, what greater service to humanity can there be than relieving someone of their suffering following a traumatic accident?

Question:
Tell us about the case in which a patient’s hand had been completely severed and you reattached it after some time.

Answer:
Yes, that was a young boy named Anas Iftikhar. You may have seen it covered in the 9 PM news bulletin, and Jang newspaper even published an editorial about it. The boy was on his way to a wedding in a Suzuki van when the vehicle met with an accident. His arm was severed at the shoulder. It was night, and in the darkness, bystanders only noticed the injured child—they didn’t see the severed limb.

The boy was brought to AO Hospital. Only after arriving did it become apparent that his arm was missing. Meanwhile, the relatives who had remained at the accident site found the detached arm and took it to Ziauddin Hospital. The doctors there asked whose arm it was, noting that no patient matching the description had arrived. From there, the relatives went to Abbasi Shaheed Hospital, where they were advised to check AO Hospital.
When they finally reached here and saw the child, their joy knew no bounds. We immediately performed surgery on the child, and by the grace of God, he is now perfectly healthy, and the reattached arm is functioning normally.

Another similar case involved a boy named Muhammad Ilyas, who worked in a factory. His hand was completely severed by a machine. I performed surgery on him within 53 minutes, and he has now fully recovered.

To date, I have performed eight such re-implantation surgeries, five of which have been completely successful. The remaining three were unsuccessful not due to any technical or medical failure, but because they were brought to us too late—after the critical window had passed. One patient came from Kotri, another from Thatta, and one from a distant part of Karachi.

In such cases, time is of the utmost importance. If there is more than a one- to one-and-a-half-hour delay in reaching the hospital, the chances of success decrease drastically. Preparation for the operation and reestablishing blood flow also require time. If more than two hours pass, the severed limb is no longer viable—its chance of revival is extremely low. Even so, we make every possible effort, but the likelihood of success becomes minimal. Occasionally, cases have succeeded even after two-and-a-half hours, but those are rare.

Orthopedic surgeons generally get very little rest. You may be surprised to learn that over 80% of Pakistan’s senior orthopedic surgeons have undergone bypass surgery themselves. I do not think it appropriate to mention names, but the reality remains.

Question: Considering the types of surgeries you perform here, how do you think India compares to us? Are they ahead or behind in this field?

Answer: When it comes to general surgery, India is definitely ahead of us. However, in the field of orthopedic surgery, they are certainly behind. On the other hand, in cardiac surgery, they are ahead of us. Given the lack of attention towards science and technology here, and the shortage of medical facilities, it is a matter of pride that in at least one specialized branch of medical science, we have surpassed India.

When I returned to Pakistan in 1980, our standard in orthopedic surgery was comparable to that of Bangladesh. But over the past fifteen to sixteen years, we have established our own standing in this field. I can proudly say that in orthopedic surgery, we are not behind England, the United States, Germany, or any European country. In fact, considering the challenging circumstances under which we handle complex cases here, we are ahead of them. This fact alone is enough to surprise doctors from the U.S. or Western Europe.

This is why our clinic is the only private facility in Pakistan recognized by the Royal College of Physicians and Surgeons of England for FRCS training. No other private institute in Pakistan holds this distinction; even the orthopedic department of Aga Khan Hospital is not recognized for FRCS training.

Interestingly, when the Royal College’s inspection team visited and assessed our work and standards, they accepted us without hesitation. In their two-page report, they wrote that the surgical training in orthopedics at our hospital is on par with, or even superior to, the standards in the United States and England. This is because our staff is highly educated and well-trained. We have the latest equipment and facilities. As you can see for yourself, the hospital is impeccably clean. Our staff is highly conscientious and efficient, which allows us to maintain an exceptionally high standard of surgery. These factors make a significant difference.

Question: Pakistan’s cities are separated by long distances. Don’t you think there should be a hospital meeting these international standards closer to northern areas like Islamabad or Peshawar, so that people there can also benefit from such facilities?

Answer: I have served as the Secretary-General of the Pakistan Orthopedic Association for four years, and as you know, the Secretary-General is the most active official in any organization. I have often expressed the wish that at the government level, there should be an Institute of Orthopedic Surgery in Islamabad, Peshawar, or Lahore. This institute should have all the necessary trained staff, surgeons, the latest equipment, and essential facilities.

I have great pride and confidence in Pakistan’s orthopedic surgeons. Lahore, for example, has many excellent doctors. If the government shows interest and takes the initiative, a top-quality, internationally standard Institute of Orthopedic Surgery can definitely be established in the northern regions as well.

My greatest wish and dream in life is that any citizen of our country who suffers an injury or wound will feel assured that by coming to such an institute, they will receive proper treatment and their worries will be eased — just as people in Karachi now feel confident that if they have any injury or bone fracture and visit the AO Clinic, their treatment will be successful.

Question: If the government decides to establish such an institute, would you be willing to offer your advisory services or contribute your time as a visiting professor?

Answer:
I am fully prepared to offer all kinds of services for such a proposed institute. Not only can I provide consultancy regarding equipment and staff training, but I can also advise on the construction of the institute’s building. This is important because there is a fundamental difference between constructing a hospital or institute building and a hotel building. A hospital or institute is not just about erecting rooms; its design must follow specific requirements and planning. For example, where should the outpatient department (OPD) be located? Where should the patient rooms be? On which floor should the operating theatres be, and how large should they be? If my services prove useful, I cannot imagine anything more gratifying than that.

Question: What is the greatest and most important wish of your life?

Answer:
My late father, Justice Asghar Ali Shah, used to say — and this remains my greatest wish as well that may Allah grant us success both in our faith and in this world. All other desires are encompassed within this single wish. If a person attains success in both religion and worldly life, what else could there be to wish for?

Question: Please tell us about the Justice Asghar Ali Shah Cricket Stadium you built in memory of your father.

Answer:
This stadium is located in the North Nazimabad area of Karachi. It was constructed in 1992 and is leased from the Karachi Municipal Corporation (KMC). Undoubtedly, it can be called Pakistan’s most beautiful, clean, and well-equipped cricket stadium. There is no other stadium of this kind in Pakistan. A European journalist named Ina, who visited here, remarked that she had never seen a more beautiful stadium in Pakistan.

This stadium hosts first-class matches, including the Quaid-e-Azam Trophy and Champions Trophy matches of Grade One and Grade Two. Typically, teams playing on most grounds have to pay substantial fees, but no fees or charges are taken from teams playing at this ground. Teams from any region in Pakistan can use this ground freely.