Monthly Archives: Nov 2017

The Human Spirit

The drive and determination of the Human Spirit never ceases to amaze me.
On the first of October 2017, a young man in his early thirties was airlifted from a motorcycle accident scene on the N7, by the AMS helicopter. He arrived awake, but lost lots of blood due to his severe injuries:
Open right femur/ thigh bone fracture
Open right forearm and elbow fracture with degloving of the covering muscle and skin
Traumatic amputation of the right ankle

All his wounds were contaminated with various pieces of dirt, grass, soil, and bits of tarmac. Through God’s Grace, vital organs, spine, and pelvic injuries were avoided.
The Mangled Extremity Severity Score of his right arm was 7, which means that it would most likely result in amputation, and therefore should ideally be performed emergently, to prevent later complication and morbidity. Unfortunately, he had already lost his right leg, which meant that losing his right arm in addition, would make rehab and walking extremely difficult.
We initially performed damage control surgery at the time of admission to decontaminate his wounds and stabilize the fractures externally, afterwards he was transfused and allowed to recover in ICU. He had lost so much blood that he actually went into shock, and required medication to support his heart and maintain perfusion of vital organs. Before and after the first procedure, his family were adamant that we make our best efforts to save his right arm, in spite of my advice on the contrary. They believed that he would be able to make a recovery and keep his arm although we had counselled them on its poor prognosis. Myself and two other Surgeons all agreed that his right arm required amputation, and that it should have been performed at the outset, to prevent later complications like pain, poor function, and infection.
I am extremely proud to say that I was wrong.
After over 7 procedures, 6 surgeons, and an approximate total of twenty hours in theatre and close to 10 units of blood, as well as 6 weeks in hospital, the patient is now able to mobilize on his good leg with a crutch in his left arm- hopping down 3 floors to the coffee shop and back up again, while waiting for a prosthesis to be fitted to his right leg. He received multiple procedures to the arm, culminating in fixation of the arm bone, excision of the radial head at the elbow, so that a primitive articulation can take place between the forearm and arm bones at a false elbow joint. Our Plastic Surgeon also managed to cover his elbow by applying a muscle flap over the bone and metal. The patient never felt sorry for himself. He never gave up. He was determined from the day he woke up, that he would walk out of the hospital.
And he has.
I have never been more proud, or more pleased, to have been wrong.
I am once again humbled by the determination of the Human Spirit.