A year of teamwork restores a patient’s arm after a devastating accident VUMC reporter

A year of teamwork restores a patient’s arm after a devastating accident  VUMC reporter

Justin Stehr, OTR, CHT, an occupational therapist in the Hand and Upper Extremity Division of the Department of Plastic Surgery, works with Dawn Reed on neuromuscular re-education of her wrist extensors and grip strength.  (Photo by Susan Orme)
Justin Stehr, OTR, CHT, an occupational therapist in the Hand and Upper Extremity Division of the Department of Plastic Surgery, works with Dawn Reed on neuromuscular re-education of her wrist extensors and grip strength. (Photo by Susan Orme)

By Jill Klending

Forty-year-old Dawn Reed carefully places a blood pressure cuff around the arm of Vanderbilt University Medical Center occupational therapist Justin Stehr, OTR, CHT, and deftly presses the bulb to inflate the cuff.

On her right forearm is a tattoo that reads in shaky cursive: “I was not created to be broken.” For Reid, and those who know of her recovery from a serious arm injury, these words are fitting.

Over the course of more than a year, hundreds of providers from emergency medicine, trauma, orthopedics, plastic surgery, and occupational therapy played a role in saving and restoring function to Reed’s right arm and hand after a UTV accident in July 2022. Many who helped her with her recovery and rehabilitation They describe her recovery as nothing short of a miracle.

Reid laughs when she says she still doesn’t have much feeling in her right pinky and ring finger. She knows that without the dedication and skills of the people at VUMC, she likely wouldn’t have a right hand at all, much less an arm.

Today, Reed steadily checks off her list of accomplishments using her right hand and arm: signing her name, brushing her teeth, pulling things out of the refrigerator. She is regaining the skills she will need to return to her career as a medical assistant. It has taken dozens of surgeries, weekly occupational therapy sessions, and a mountain of personal determination to get to this point.

At the time of the accident, Reed was living in Michigan and visiting friends in rural Franklin County, Tennessee. The group decided to take a late night off-road trip. Reed was a passenger when the driver of her UTV made a sharp turn to execute a donut. She instinctively reached the car’s cage before it rolled over.

“I remember waking up with blood pouring out, and my arm was trapped under the cage,” she said. “I panicked and started swaying. Once the dust settled, the men realized what had happened and were able to lift the car off my arms.”

They headed to the nearest road to receive an ambulance. Reed’s mutilated arm was tightly bound by shirts, and she held several bone fragments in her left hand. She was transported by LifeFlight helicopter to the VUMC Emergency Department Trauma Section. With the gravel and dirt removed, the emergency department team assessed her catastrophic injuries.

Dawn Reed's new tattoo was intentionally placed as free flap surgery performed by plastic surgeons at Vanderbilt University Medical Center saved her arm from amputation.  (Photo by Susan Orme)
Dawn Reed’s new tattoo was deliberately placed as free flap surgery saved her arm from amputation. (Photo by Susan Orme)

Every structure in her arm was damaged – bone, skin, ligaments, muscles, tendons and nerves. Reid’s arm was “de-gloved”, meaning the upper layers of skin and tissue were torn away from the underlying muscle, connective tissue and bone. The radius and ulna bones were shattered, with one-third of the ulna or its fragments missing.

Hand and upper extremity orthopedic surgeon Mihir Desai, MD, was on call when Reid arrived. He and his team began a four-hour surgery to reconnect viable internal structures to give her arm the best chance of regaining blood flow and nerve regeneration. A metal plate was added to replace the missing bone. The remaining skin of the arm was stitched together, and broad-spectrum antibiotics were given to ward off infection.

After surgery, Reed wanted to return home to Michigan. The requirement was that she immediately contact specialists there to administer ongoing intensive care and rehabilitate her arm.

In Michigan, after an exploratory surgery to remove skin that had begun to die, an orthopedic surgeon and a plastic surgeon agreed: She needed immediate transport to the University of Michigan Medical Center, where her arm would likely be amputated.

“You just have to go back to Vanderbilt,” my friend told me. “They’re the ones who saved your arm,” Reed said. “My family agreed.”

A Michigan orthopedic surgeon called Desai to inform him that Reed would be returning to VUMC. Desai felt she needed to have a “free flap” procedure if there was any chance of saving her arm. He enlisted the help of two experts from VUMC’s Department of Plastic Surgery, Brian Drolet, MD, chief of hand and upper extremity surgery, and Brad Hill, MD, director of extremity reconstruction. Plastic surgeons at VUMC are experts in free flap procedures to help manage large wounds.

Reed, her mother, and her 13-year-old daughter, Aria, whom she credits with constant support, returned to Nashville on a more than seven-hour flight. Reid said her arm looked like something out of a “crazy horror movie.”

“I distinctly remember meeting her in the operating room,” Drolet said. “We were looking at a large soft tissue defect, with exposed bone and hardware. We knew right away that this was going to be a big problem to address.

“I told her we had some big decisions to make, and we had a long way to go to regain the use of her hand. ‘I want to do everything I can to save my arm and hand,’ Don said. ‘Tonight, we’re going to clean things up and start making a plan to do just that,'” Don said. .

For Reed’s next major procedure, Drolet is joined by Galen Perdikis, M.D., chief of plastic surgery. For the free flap procedure, surgeons transferred a portion of skin and tissue from her thigh to her arm to replace the failing tissue. The procedure involves delicate microsurgery to reconnect arteries, which carry blood to the flap, and veins, which allow blood to flow. Surgeons also replaced metal devices to hold Reid’s bones together.

“After surgery, Dawn went to the surgical intensive care unit where they checked that flap every hour with a Doppler to monitor blood flow,” Drolet said. “There is high-intensity post-operative care.”

Shortly after being discharged from the hospital, Reed began working with Stehr, an occupational therapist in the plastic surgery department with special training in trauma, wound care, and specific therapy for the hands and arms. By sharing the same space with surgeons, more collaboration and check-ins can be achieved when patients come in for treatment appointments.

Reed began seeing Stehr twice a week, where she focused on relearning the tasks she needed to do in her job as a medical assistant. Smaller, incremental surgeries were performed over the next year with Drolet and other members of the plastic surgery team to improve the function and range of motion of her arm and hand.

“I moved here pretty soon because Vanderbilt was great,” Reed said. “Everyone who played a role in saving my arm and helping me recover was amazing.”

Stehr has used ultrasound therapy to help reduce swelling and inflammation and has built several custom braces to support healing and proper function. With injuries Reed’s size, rehabilitation often focuses on regaining enough use so the limb can assist with basic grasping or stabilizing objects, but she continued to defy the odds.

“Our goal was always how to get her to have as much mobility, recovery, and strength as possible, so that she would have as good a chance as possible of success when the next surgery happens,” Stehr said.

“There were always little little challenges, like not being able to get the range of motion that we were aiming for. As far as the big challenges, it was just about trying to get it to function. We knew we weren’t going to get it back to the point it was at before the injury before it had to To get back to work and to a more normal life. We were always facing problems week after week.

Stehr credits Reed for her amazing rehabilitation. She went to the gym, worked on exercises to strengthen her arm and hand, and didn’t let small setbacks hinder her progress.

“One week, she said, ‘I really want to be able to write my name,’” Stehr said. “So, we worked on it. She showed up the next week and said, “Guess what, you wrote my name down!”

“She now has a very well-functioning arm and hand. She has great strength, and will have better mobility and strength. To me, this shows the value of patient-driven care, where the patient is very involved and takes something that could have been catastrophic and progresses steadily.” To the point that she would generally use her arm very well.

Hill, who directs limb reconstruction in the Department of Plastic Surgery, evaluated Reed during one of her treatment appointments and gave her welcome news.

“He told me I have more function in my hands and arms now than I would have with any type of prosthetic I might have,” Reid said. “If it wasn’t for Vanderbilt, I honestly don’t think I would have the right hand right now.

“There were times when Dr. Drolet would say to me, ‘You’re not out of the woods yet.’” She remembered that she would probably lose this arm. “I told him, ‘Oh, you’re not taking my arm from me. It may not look pretty because of all the scars, but it’s mine!'”

    (Tags for translation) Arm Surgery 

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