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Almost every case turns on an interval.

Fifty-three cases, ordered by the clock each one runs on: six hours of tissue viability, sixty-six hours to treatment, fifteen years untreated. Switch to the figure index to browse by diagram instead.

53Cases published
52Original diagrams
1Reviewing physician

Hours

Where the tissue is still alive and the window is closing
  1. 0 hmachine still attachedMC-026EmergencyThe hand arrived still inside the machineA welder freed him in theatre. The amputation was decided by something much simpler than the damage.
  2. 3 h 52 minto remove a 63.5 cm rodMC-043EmergencyIt ran from his pelvis to his neck and missed every major vesselA 45-year-old man arrived stable, with abdominal pain. The scans showed a wooden rod running from his rectum to the right side of his neck, without cutting a single major blood vessel on the way.
  3. within hoursone heart, two bodiesMC-008ChildrenParasitic twin: the twin with no heartA second head with eyes and lips, and no circulation of its own. Waiting would have made her weaker, not safer.
  4. 45 minfrom arrival to theatreMC-040ReconstructionHalf his face was torn away. It was all put back in one operation.A motorcyclist arrived with the left side of his face torn and peeled back, and his own tissue blocking his airway. Surgeons put every layer back in a single operation, and two weeks later he went home.
  5. 3 hafter the biteMC-005EmergencyViper bite coagulopathy: the scan that showed nothingThree hours after the bite his blood could no longer clot. A normal ultrasound is what kept him out of theatre.
  6. 4 hto blood flowing againMC-038ReconstructionThey operated on the hand before they operated on himA machine took his hand off through the forearm. One team worked on the hand on a side table while the other prepared him, and blood was crossing it again four hours later.
  7. 6 hof viabilityMC-010ReconstructionReplanting an arm: the clock, and the harder questionSix hours of viability, and a decision about whether to reattach a limb the patient removed himself.
  8. 24 huntil the marks fadedMC-044EmergencyA lightning pattern spread across his skin, and was gone within a dayAn electrician was struck by an arc from a 20,000-volt unit he thought was switched off. Red, branching marks like a fern spread across his side, and within 24 hours they had vanished.
  9. 34 hfrom walking in to deathMC-033InfectionA stomach ache, no fever, and septic shockShe looked well and was afebrile. Her blood pressure was 75 over 50 and her white cell count had almost vanished. The organism was named after she died.
  10. 66 hto treatmentMC-020EmergencyHe stayed at Camp 4 to help another climberGrade 4 frostbite, treatment 66 hours late, and he lost half of two toes.
  11. on arrivalsitting forward to breatheMC-031EmergencyHe could breathe sitting up, but not lying downHis face hit the steering wheel and the midface came away from the skull. The position he was holding on arrival was the finding that mattered most.

Days

Long enough for a drug or an infection to declare itself
  1. a few daysbetween the two operationsMC-029ReconstructionTwo flaps, and no microscopeA radical resection took the left side of his mouth. Both muscles used to rebuild it stayed joined to their own blood supply and were swung into position.
  2. same dayinfected from the same sourceMC-030InfectionBoth boys were infectedThe most reproduced vaccination photograph in medicine is usually captioned wrongly. The vaccinated boy caught smallpox as well. It simply never got going.
  3. 2 daysrash to diagnosisMC-012DiagnosisPurple ears: the adulterant, not the drugA net-shaped rash, collapsing neutrophils, and antibodies pointing two ways at once.
  4. 5 daysbefore anyone looked againMC-006DiagnosisWooden foreign body on CT: the scan said gasWood reads as air on a scan. The clue that overturned the report was an infection that would not settle.
  5. 5 daysin hospital after the attackMC-047EmergencyThe lion was a gift. Three weeks later it attacked him.A 17-year-old was attacked by the pet lion his father had given him. He arrived in shock, with his scalp torn loose and a broken skull, and went home five days later.
  6. 6 daysbefore anyone could undo itMC-027ReconstructionThe shark did not cause the contractureThe bite took tissue. The hand was lost to a wound closed too tightly, and by the time she reached a second hospital it was already fixed.
  7. 1 weekheadache to confusionMC-016InfectionThe abscesses in his brain came from his teethThe veins of the face have no valves. Nothing stops infection travelling the wrong way.
  8. 10 daysof leeches, and ten litres of bloodMC-034ReconstructionThe bleeding was the treatmentHer scalp came off in one piece and was sewn back on within four hours. Getting blood in was the easy half; the flap was drowning in blood that could not leave.
  9. 10 daysfrom impalement to homeMC-036EmergencyThey cut the branch down. Nobody pulled it out.A road accident drove a branch through the side of his face and out of his mouth. It was cut from eight feet to two, left in place, and removed only once the vessels around it could be controlled.
  10. 11 dayswound to first spasmMC-015ChildrenThe wound was cleaned. She still got tetanus.She reached a hospital the same day. The one injection that would have prevented it was never given.
  11. 12 dayson the drugMC-017DiagnosisIt looked like a virus. It was the medication.He was taking lamotrigine. Much of the risk with that drug is in how fast the dose goes up.
  12. 21 daysin hospitalMC-053EmergencyThe chainsaw kicked back and cut him a second mouthA chainsaw kicked back into a man's face, opening his cheek into his mouth. Getting a breathing tube in safely meant giving him oxygen through the wound.
  13. 23 daysin hospital after the attackMC-046ReconstructionThe bear went for his face, and left its tooth marks in his skullA man gathering pine nuts alone in a Siberian forest was attacked by a bear. He walked away and reached hospital nine and a half hours later, with his upper jaw torn loose and tooth furrows in his skull.

Months

Healing itself becomes the injury
  1. 6 weekswith the plate outside his legMC-042OrthopaedicsThe bone plate was screwed on outside his legA crocodile bit a 13-year-old boy and broke both bones of his lower leg through the skin. Working with limited resources, his surgeons sterilised a used bone plate and fixed it to the outside of his leg.
  2. 2 monthsfrom operation to lost to follow-upMC-028ChildrenThe surgery was free. The cure was not.A visiting team removed a childhood sarcoma at no cost. The chemotherapy that decides whether she lives was months away, and her family could not follow it.
  3. 2 monthsto close without surgeryMC-037ReconstructionThe steroid was for his muscles. It killed the skin above them.A black-market steroid injected into both buttocks left two full-thickness wounds. Antibiotics could not touch them, and the surgeons closed neither.
  4. 3 monthswith his ear cartilage in his abdomenMC-045ReconstructionThey saved his ear by keeping it inside his bellyA road accident tore off a 22-year-old's ear, and the wound was too damaged to sew it back. Surgeons buried its cartilage under the skin of his abdomen and brought it back to his head three months later.
  5. 5 monthson the back of his other handMC-051ReconstructionHis thumb lived on the back of his other hand for five monthsA man's severed thumb could not go straight back, so surgeons sewed it onto his other hand and moved it home five months later, with a joint from his foot.
  6. 6 monthsand seven major operationsMC-049ReconstructionHer lost arm gave its nerve to her leg, and her toe became a thumbA shark attack took a woman's left hand, the thumb and two fingers of her right, and 16 cm of her sciatic nerve. Her surgeons rebuilt what they could from what the attack had left.
  7. 7 monthsbefore he was referredMC-021ReconstructionHe was a face transplant candidateThe surgeon who assessed him performs face transplants. He rebuilt this patient from his own tissue instead.
  8. 10 monthswithout a surgeonMC-003ReconstructionBurn scar contracture: face healed to the chestTen months without a surgeon turned a survivable burn into a disfigurement that took twelve operations to reverse.
  9. 1 yearof a brain under pressureMC-032ChildrenA twin inside a skull, benign and still fatalIt had a spine, a face and hands, and it was not a cancer. The only thing that decided the outcome was where it happened to grow.
  10. 15 monthsfor the wound to closeMC-018InfectionIt does not eat flesh. It cuts off the blood.Her IV antifungals were not working. The answer was to stop relying on the bloodstream entirely.
  11. 16 monthsthe gap in median diagnosisMC-009ChildrenRetinoblastoma: the cancer a photo can catchOver 95% survive when it is found early, around 40% when it is not. The tumour is the same.
  12. 17 monthson the transplant listMC-041ReconstructionHe waited 17 months for a face that matched his ownA drunk driver's crash took Robert Chelsea's lips, part of his nose and his left ear. The first full face transplant in a Black patient took longer to arrange, because the donor had to match more than his tissue type.
  13. a yearin silenceMC-019ChildrenThe operation removes the hairball, not the habitHair cannot be digested and cannot be pushed along, so it stays and builds for a year in silence.

Years

The interval no one was counting
  1. 1,500 hof dissectionMC-025AnatomyTwo students, 1,500 hours, and no shortcutVessels can be filled and cast. Nerves are solid, so the only method is removing the body around them.
  2. 3 yearsfrom the crash until she was seenMC-039DiagnosisThe silicone in her arm came from her breast implantAfter a car crash her left breast swelled for nearly three years, and the MRI raised concern for cancer. It held about 600 millilitres of organised haematoma, and silicone from her other implant had reached her right arm.
  3. 3 yearswithout recurrenceMC-052ReconstructionThe tumour covered half her face. Surgeons rebuilt it from the tumour's own skin.A 74-year-old arrived with the largest tumour of its kind on record, across half her face. It came out in one piece, and its own skin closed the hole.
  4. 6 yearsfrom the gunshot to a new faceMC-054ReconstructionA gunshot took his face. Canada's first face transplant gave him a new one.An accidental gunshot left a man unable to chew, swallow or speak normally. In 2018 he received Canada's first face transplant, and his surgeons counted every dollar.
  5. 7 yearson the waiting listMC-055ReconstructionThirty-five operations could not stop the tumour. A new face did.A tumour had grown through a young woman's whole face despite 35 operations. After seven years on the list, she received a 19-year-old donor's face, ears and scalp.
  6. 9 yearsof follow-upMC-050ReconstructionHer whole scalp came off in one piece. Nine years later, her hair is back.A machine shaft caught a woman's hair and tore away her entire scalp. Surgeons reattached it, rejoined its vessels and pinned it down in a spiderweb of stitches.
  7. 10–25 yrshow long implants lastMC-013OrthopaedicsA knee replacement does not replace the kneeAbout a centimetre comes off each surface. The rest of the operation follows from that.
  8. 14 yearsand 70 operationsMC-022ReconstructionHe was not going blind from the fireHis eyes survived the burns. His eyelids did not, and nothing grafted can be made to blink.
  9. 15 yearsuntreatedMC-007ReconstructionKeloid vs hypertrophic scar: fifteen years untreatedMinor cuts to the jaw, no treatment available, and fifteen years for a scar to become a disability.
  10. 15 yearsbefore the transplantMC-011ReconstructionTwenty operations rebuilt his jaw. None gave him a face.Reconstruction restores structure. A face is not structure. What the transplant cost him came seven years later.
  11. 20+ yearsbefore he agreed to surgeryMC-048DiagnosisHe lived with it for 20 years. It weighed 20 kilograms.A 90-year-old man refused treatment for a slow-growing lump on his hip for more than 20 years. When it began to affect his walking, surgeons removed a benign fatty tumour of 20 kilograms.
  12. 28 yearsone side, by the windowMC-035DiagnosisThe window stopped the sunburn, not the damageTwenty-eight years at the wheel of a delivery truck, and only the side of his face next to the glass aged. Window glass filters out the rays that burn and lets through the ones that go deeper.
  13. 50 yearsafter birthMC-014DiagnosisA vein that closed at birth, reopened fifty years laterCaput medusae is the visible detour. The one that kills is in the oesophagus.
  14. yearsof slow expansionMC-023ReconstructionIt was never cancer. It still had to come out.Benign and harmless are different words when the skull has no spare room.
  15. 1824the first lithotrityMC-004HistoryBladder stone surgery in 1824: the nail-and-hammer mythNo nail, no hammer. A blind operation inside a conscious man's bladder, and the first minimally invasive surgery.
  16. since 1663the method itselfMC-024AnatomyYou are not looking at blood vesselsThe vessels were dissolved too. What is left is the shape of the space inside them.