Advances in Hand Surgery
Rx Investors | 9/3/10
My Personal Experience with Two Severe Hand Injuries
By Justin M. Hall
Injury to Left Arm and Hand, July 1991
In July 1991, I was involved in an auto accident on my way to the lumber yard I was working that summer before my last year of high school. Another vehicle that was heading in the opposite direction was traveling in the middle of the road. Instinctively and thankfully, I swerved to avoid a possible head on collision with the other vehicle. However, I did collide with a fence surrounding a horse pasture. As result, a 2x6 fence board was impaled into the bend of my left arm.
Following a vivid dream, I recall waking to a man, who I will not name to protect his privacy, holding my left arm firmly in order to keep it from bleeding. Based on the amount of blood loss, I learned later that I was barely clinging to life. Had the man not been home that morning or had he simply responded one or two minutes later than he did, I would not be telling this story today.
The next time I awoke, the man was still holding my arm and a Deputy Sheriff, who I will not name to protect his privacy, was bent down at whatever was left of my passenger side window. Apparently, the Deputy had been trying to communicate with me because when I [finally] responded, he seemed to be very glad to hear from me. I recall that he got choked up when he said to me "just hang in there, bud." When you hear a police officer's voice crack, you know you are pretty beat up.
I spent a few days in the intensive care unit (ICU) at Methodist, which I barely have any recollection. Following a brief stay in ICU (a good thing), I spent another two weeks in the hospital recovering from the injuries sustained in the accident. A skin graft was taken from my left thigh to patch up the injury at the bend of my left arm. I lost some muscle in my arm and the radial nerve had been severed during the accident. The radial nerve damage limited my ability to lift my hand and fingers up. I was also unable to rotate my left hand palm up. So, additional work was needed.
The first doctor, whose name I cannot recall, suggested amputating my left arm and providing me with a hook. I recall laughing and impolitely telling him to leave my room. And he did. I never did see him again.
So, I contacted a friend from school, who had also sustained a serious injury to his hand and arm. He referred me to Dr. James W. Strickland at the Indiana Hand Center located on the campus of St. Vincent's Hospital. In November 1991, Dr. Strickland performed a tendon transfer on my left arm, which enabled me, after a few months of therapy, to lift my left hand as well as rotate it palm up. While there are still limitations, I am able to use my left arm and that sure as Hell beats a damn hook. Thank you Dr. Strickland!
Injury to Right Arm and Hand, July 2000
Nine years and almost to the day, I injured my right hand in July 2000 while cleaning a paint sprayer. The gun on the sprayer inadvertently fired off with safety engaged and power off. As result, a stream of paint thinner and oil based paint was injected into the tip of my index finger and spread throughout my forearm. Needless to say, this was a very painful injury. Ultimately a portion of the index finger on my right hand was amputated. While it took five years, I did settle with the manufacturer.
The top set of photos were taken in 2000 after returning home following a two week stay at St. Vincent's Hospital in Indianapolis. The second set were taken in 2009.
Richard Edwards Jr.'s Story
I also wanted to share this chiropractor's incredible story. After sustaining two different severe injuries to both of my hands and arms within a decade of one another and prior to my 27th birthday, Mr. Edwards story hit home. After reading it, I was compelled to share both of our stories.
I am praying that Mr. Edwards has a smooth recovery and can get back to his work and family. His story touched my heart. I'm sure it will also touch yours.
Double-Hand Transplant Patient Longs to Hold Wife's Hand
Eight days after receiving the region’s first double-hand transplant, Richard Edwards Jr. curled the fingers of his left hand to make a fist. Then he tried to do the same with his right hand, achieving a half-fist.
“This is the result you’d expect in six months!” Dr. Warren Breidenbach of Kleinert Kutz and Associates said at a press conference Thursday morning at Jewish Hospital Rudd Heart & Lung Center.
Edwards, 55, of Edmond, Oklahoma, smiled broadly.
“I feel fantastic,” he said later. “I’m feeling very blessed and thankful for having a new pair of hands.”
Edwards said he hopes the transplant allows him to someday return to his former job as a chiropractor. But what he wants most, he said, is to hold hands again with his wife, Cindy, and feel her touch.
“I love to hold my wife’s hand,” he said, his voice breaking as he looked at the woman sitting beside him.
Edwards received his new hands in a 17 ½-hour operation that began Aug. 24 and ended Aug. 25 at Jewish Hospital Hand Care Center. A team of surgeons from Kleinert Kutz and Associates and the University of Louisville performed the surgery, the nation’s third double-hand transplant after two in Pittsburgh.
Jewish has also been the site of the nation’s first five single-hand transplants.
Unlike other hand-transplant patients, Edwards came to doctors with existing hands — although they were burned so badly that they didn’t function. Doctors removed them during surgery, including the muscle and bone, but kept the nerves, slipping them inside his new, transplanted hands.
“This is a breakthrough transplant,” Breidenbach said. “This is the first time we allowed tissue to stay present.”
And the early results are promising, he said.
“This is the best motion of any hand transplant we’ve ever done,” he said.
Injured in truck fire
Edwards lost the use of both hands when his truck caught fire in 2006.
Unable to escape, he suffered burns on more than 30 percent of his body, including severe burns on his face, back, arms and hands — leaving him with seven missing fingers and little tissue on either hand.
Before the accident, Edwards was working as a chiropractor in a busy practice and said, “My sense of touch was incredible.”
Afterward, he could no longer unzip his pants without help, let alone check a patient’s spine.
“My life came to an absolute standstill,” he said. “It was a total 180-degree turn.”
Cindy Edwards said her husband “went from this vivacious person full to life” to someone struggling emotionally and mentally.
“He could not rise above the depression he felt,” she said.
Since his injuries, Edwards had multiple reconstructive surgeries and skin grafts but remained unable to use his hands. He began working with Louisville doctors almost three years ago.
Cindy first suggested the transplant to her husband and the doctors.
“I’m very thankful to the team and to God that I’ve been accepted and I made it all the way through the testing,” said Edwards.
Edwards was put on the transplant list and got the call about two weeks later that hands had become available. He and his wife rushed onto a plane at 6 a.m. Aug. 24, arriving in Louisville at 11 a.m.
As doctors prepared him for surgery, he said he made a pact with himself to resist going under the anesthesia for as long as possible. The next thing he knew, he said, he was waking up.
“I just laid there thinking: When are they gonna start? A few minutes later someone said everything was successful,” he said. “I’m so thankful I had a team of doctors who could think outside the box and take a chance like that” — giving new hands to someone who already had hands.
Risk was acceptable
Edwards now faces a lifetime of anti-rejection drugs.
Doctors are suppressing his immune system with a combination of four drugs, including steroids, and monitoring him for signs of rejection. Side effects of these drugs can include impaired kidney function and even a shortened life.
Critics question the wisdom of subjecting patients to harmful or even deadly side effects when hands are not essential for life.
While hand transplants are hailed as a groundbreaking medical achievement, the work hasn’t been without setbacks. In April 2009, doctors had to remove the transplanted right hand of David Robert Armstrong of California, the nation’s fourth hand transplant recipient. Dr. Michael Marvin, chief of transplantation at Jewish Hospital/University of Louisville, said the way his steroid was quickly minimized may have contributed to the loss of his hand, although he’s not sure. Marvin said doctors will be slowly weaning Edwards from the steroid he is taking.
Edwards said he considered the possibility of complications — including losing his hands — but still wanted the transplant. He said he and his wife trusted it was God’s will, and that gave them peace.
“My life had become so dull and at a standstill,” he said, moving his arms and hands while he spoke.
“I think it is well worth the risk.”
Ultimately, Edwards said he would love to return to his career as a chiropractor.
“I don’t know if I can, but I hope I can,” he said. “At least I can start doing things.”
Breidenbach said the nerves are close to where they’ve got to grow to, but it will take a while before Edwards could possibly feel spines again. He said Edwards also needs to build strength in his hands.
Both hands are now in large braces, which were propped on pillows at Thursday’s press conference. Edwards has been rubbing his forehead with a brace and has an abrasion on the sensitive skin that was burned and reconstructed.
Edwards is scheduled to get out of the hospital Friday but will live in a local hotel suite for three months as he undergoes extensive rehabilitation.
Cindy Edwards said she’s hopeful that the hands return to her husband the spark of life he once had.
“What I look forward to most,” she said, “is getting my husband back.”
Source: Louisville Courier Journal
Reporter Laura Ungar can be reached at (502) 582-7190.
Related: Hand transplant patient speaks