By Starla S. Collins of the Arizona Daily Sun (Read Original Article)
‘Dr. Cole created a “pocket” in Shawn’s lower abdomen/groin area where he inserted Shawn’s forearm and hand and closed the pocket around it.’
It’s been just over a year since 38-year-old Shawn Bert lost his right hand in a blast accident. Only three thin, damaged tendons kept his hand from being completely detached. The bones, muscles, blood vessels, nerves and other tissues were destroyed.
Shawn was working with an explosive device that appeared to be defective when — without warning — it exploded, blowing his right hand off. Shawn’s sister wrapped his hand while calling 911. She loaded him in the truck and quickly drove him miles down a dirt road to the Hopi Cultural Center where the ambulance was waiting.
Seeing the extent of his injuries, the EMS crew called the Guardian Air medical helicopter in Tuba City. The ambulance headed toward Tuba City as the helicopter took to the air to intercept them as quickly as possible. When both emergency units were in the same vicinity, Guardian Air landed and loaded Shawn into the helicopter.
The flight nurses worked to stop the blood flow, decrease the pain and stabilize Shawn. Four and a half hours after the accident, Shawn finally arrived at Flagstaff Medical Center and the region’s state-designated Level I Trauma Center. He was also extremely fortunate that Patrick Cole, M.D., one of the few surgeons in the nation who had the extensive training needed to handle this situation, was his surgeon.
Dr. Cole was the newest physician to join Plastic Surgeons of Northern Arizona. He has years of training in microsurgery and orthopedic hand surgery, as well as plastic and reconstructive surgery. Microsurgery is surgery at the ‘nano’ level. It requires special equipment and extensive training. Dr. Cole’s training and experience meant he had the skills to perform what is called a hand ‘replant.’
Replantation is the surgical reattachment of a finger, hand or arm that has been detached from the body. Key to replantation is the time between the injury and surgery.
“You normally only have about 6 hours to restore blood flow following this kind of injury and we were already more than 5 hours since the accident,” Dr. Cole explained. “I wanted to do everything possible to save the hand. The first thing I had to do was establish blood flow by creating a new artery. I chose a large vein from his right leg to create a new artery in the wrist that would carry blood from the arm to the hand. If the blood-restoring procedures didn’t work, then Shawn’s hand would have to be amputated above the wrist.”
Three days later, Shawn headed back into surgery, this time to remove all the damaged tissue and clean the wound. Tiny antibiotic-filled beads were placed inside the wound. The debris and destruction were so severe, another surgery had to be scheduled three days later. During this time, Shawn remained sedated in the Intensive Care Unit where his grandmother, sister and four children sat by his side, praying and hoping for his recovery.
Ten days after the surgery, Shawn returned to the OR where Dr. Cole would continue the process of ‘replanting’ Shawn’s hand. Since a portion of the radius bone in the forearm had been blown away, Dr. Cole shortened the ulna bone (the other bone in the forearm) to make the two bones even. A metal fixation device was needed to stabilize the wrist and forearm.
To help cover the massive open wounds at the wrist and forearm, Dr. Cole created a “pocket” in Shawn’s lower abdomen/groin area where he inserted Shawn’s forearm and hand and closed the pocket around it.
“We needed to create an environment where Shawn’s hand had adequate coverage,” Dr. Cole explained. “The only chance we had for the hand to survive was to provide durable soft tissue and skin coverage.”
For three long weeks, Shawn had to lay still in bed while his body worked to heal his hand. The goal was for the blood vessels and tissues in the abdomen to grow into Shawn’s arm, creating new vessels. Shawn’s groin flap procedure was only the second groin flap procedure at Flagstaff Medical Center, the first of which was also performed by Dr. Cole.
At the end of three weeks, Shawn’s hand was removed and the abdomen was sewn closed. The hand looked pink and there was evidence the replant was going to be successful.
Nearly four months after the injury, Shawn went back to surgery to undergo a bone graft and wrist fusion to stabilize the bones. Dr. Cole took a portion of bone from Shawn’s left hip to bridge the gap between the hand and the forearm. Shawn wore an external fixation device for months to ensure the bones healed properly.
A year after the injury, Shawn’s hand is functional and he has joined his grandmother in her traditional Hopi jewelry making. He can hold an ax to chop wood as needed and he can play ball with his kids.
When asked about the last year, Shawn shared the following: “I might not be here today if it wasn’t for my family who acted quickly to get me to the ambulance and helicopter. I want to thank the amazing doctors and nurses and therapists at Flagstaff Medical Center. I especially remember Dawn in the Step Down unit who always made me laugh. But mostly, I want to thank Dr. Cole. I have no doubt that if it wasn’t for him, I would not have my right hand and would not be able to use it. Dr. Cole was with me every step of the way, telling me exactly what we needed to do next. He made me believe in my recovery and work for it. I can never thank him and all the people at the hospital enough.”