October 27, 2011, U.T. Southwestern released news today of how a plastic surgeon in their facility recently used a novel technique to save the arm of a Gulf War veteran who was rushed to Parkland Memorial Hospital after a horrific accident.
According to the news release, on Aug. 27, U.S. Navy veteran Royce Reid, 49, of Gilmer, Texas caught his left forearm on a pipe in a conveyor. The machinery twisted and mangled his arm, and nearly tore it off. With it held together only by a skin bridge, Mr. Reid’s military survival training kicked in. He managed to free himself and even directed several who witnessed the accident on how to apply a tourniquet. Then he walked to an ambulance that had been called, supporting his own dangling forearm.
Physicians in a hospital in Longview determined that Mr. Reid required advanced care and expertise, so he was transferred by helicopter to Dallas. The call had already gone out to Dr. Bardia Amirlak, a hand surgery specialist and assistant professor of plastic surgery at UT Southwestern, who met Mr. Reid at Parkland’s emergency room.
Dr. Amirlak recognized that he had a tough decision to make: whether to complete the amputation, knowing his patient would be able to return home soon and be fitted for a prosthetic arm, or attempt a marathon surgery with an unpredictable outcome and months of rehabilitation.
Mr. Reid’s initial response was, “Just cut it off, doc. Just cut it off.” Dr. Amirlak however knew from his experience working with trauma patients that Mr. Reid’s initial thoughts might not reflect his true feelings.
According to Dr. Amirlak, “He was in a lot of pain, he was in shock and he was stressed from bleeding, (and) as I was going to make the decision to amputate, he looked at me with tears in his eyes and said, ‘I have grandkids and I want to hold them with my own hands. Do what you can to save my arm.”
Surgery was especially difficult because there had been a significant time lag since the initial injury, and a limb normally only remains viable for up to six hours after its blood supply is cut off. Six hours had nearly elapsed by when Mr. Reid arrived at U.T. Southwestern.
Dr. Amirlak quickly thought outside the box and improvised to save the limb. He rigged an extracorporeal transfusion, a sort of “external bypass,” to deliver fresh blood from the left femoral artery directly into the remnant part of the forearm and keep it “alive” while he worked to first reconnect the bones, then the blood vessels, tendons and nerves.
“I knew if I didn’t do this particular technique, Mr. Reid would surely lose the arm,” Dr. Amirlak said. His prior fellowship in the area of hand and microsurgery at the Christine M. Kleinert Institute in Louisville, Ky., gave him the confidence to try the rare technique. He had trained at the institute under Dr. Warren C. Breidenbach, who performed the first hand transplant in the U.S. in 1999.
Dr. Amirlak also is a team member of the new hand transplant program at UT Southwestern that launched in July.
As an academic medical center, UT Southwestern doctors see a higher rate of referral patients, including those whose medical problems go beyond the capacities of local community hospitals and require specialized services and care.
“This case exemplifies all the advances in technology and skill that we now have in our faculty at UT Southwestern, in concert with Parkland, to provide our patients with state-of-the-art care,” said Dr. Rod Rohrich, chairman of plastic surgery. “In the recent past, this war veteran may have lost his forearm. Thanks to our plastic surgery hand team, this patient will return to be a functional person in our society and workforce.”
Dr. Sumeet Teotia, who provided secondary support said, “Dr. Amirlak did something that our entire department had not yet heard about. All I can say is that I was there when Dr. Amirlak was doing this, and it was amazing. The forearm was completely shattered. He revascularized the entire limb.”
More information can be found at UTSouthwestern.edu .