UI Doctors Reattach Hand and Wrist After Tree Accident
November 21, 2012
Roger Batchelder knows what it means to be truly thankful.
The 74-year-old La Porte City, Iowa, retired fire fighter has been a patient at University of Iowa Hospitals and Clinics since Halloween, when a tree-cutting accident resulted in the complete removal of his right hand and wrist.
Thanks to the quick action of paramedics on the scene, the air ambulance crew, UI Hospitals and Clinics plastic surgeons Jerrod Keith, MD and Brad Coots, MD, orthopedic surgeon Todd McKinley, MD, and a full complement of emergency department and surgical personnel, Batchelder’s hand was saved and reattached, and he may regain some use eventually.
"Words don’t even express how grateful I am," says Batchelder. "The fact that the doctor assembled his surgical team so quickly sped the whole thing up and helped save my hand."
Keith and Coots led a surgical team that worked for eight hours to reattach Batchelder’s hand, as well as reconnecting tissue, muscle, nerves and tendons.
"We quickly and efficiently talked to Roger in the emergency department to let him know what his options were," Keith said.
He said they told Batchelder they could reattach the hand but there would be risks: it was a long surgery, there was no guarantee the hand would regain any function and because the surgery would cause a large loss of blood and need for transfusion, it could be potentially life-threatening.
"I didn’t even have to think about it," Batchelder said. "For me, I thought it would be better than a hook."
Accident in the field
Batchelder was helping a friend prepare a field to be cleared for farming in the early afternoon of Oct. 31. He said there were about eight trees that had to be cut before the bulldozer could come in to remove the stumps, and they had to be cleared that day.
"When I started there wasn’t much wind at all," he says. "A bit later I noticed the wind started to pick up so I adjusted my work a little."
Batchelder is experienced with a chain saw and has been clearing trees and brush from areas for years. When it’s time to remove a tree he cuts a wedge on the side of the tree that will bend and fall, and cuts a pair of slices in the other side to help it along.
He had already gotten five trees down, but the sixth tree was being a bit difficult. Usually when he cuts the wedge, he says, the tree starts to move toward the fall. This time, however, the tree didn’t budge. He went to the other side and cut the slits – but nothing happened.
"The wind was blowing the wrong direction, it was kind of holding the tree up," Batchelder says.
That lasted just a few seconds before things suddenly turned dangerous. The tree started falling toward the slits rather than the wedge – and right toward where Batchelder was standing.
"I saw the tree starting to come at me so I started to back up," he says.
He backed up to get away from the tree but stepped in a hole and got stuck. The tree, he said, fell on his arm, right above his wrist. He thought the tree crushed his arm against the stump.
"The tree hit me in the chest and I fell to the ground. I pitched the chain saw off to the side so I wouldn’t land on it," he says.
Batchelder’s wife, Patty, was just a few yards away with the couple’s truck when she saw the tree begin to fall. She immediately drove over to where he husband was lying.
"There was the tree, the chainsaw, Roger and there, by the tree, was his hand," she says.
Roger Batchelder never lost consciousness. His wife applied pressure and told him to hold it, and she drove to a neighbor’s house to call 911.
"We didn’t have cell phones with us," she said.
At the hospital
Keith said Patty Batchelder’s quick thinking, the air ambulance crew salvaging the hand and keeping it on ice and the inclusive nature of UI Hospitals and Clinics, which allowed him to pull a surgical team together within minutes, combined to make reattachment possible.
"You typically have a five- to six-hour window from time of trauma to surgery to have a successful reattachment of the forearm," he says. "The longer it is kept on ice, the better the chances."
Though amputated fingers and even hands have a longer window of time before surgery, the fact that this included part of the forearm complicated the surgery, Keith said, and shortened that time availability. While Batchelder was still in the emergency department, Keith and Coots took the hand to the operating room to begin preparing it for surgery, which included identifying all of the nerves, tendons, and tissues.
"The team atmosphere makes this successful and possible," Keith says. "That is the key to success, having everyone involved."
Though Roger Batchelder’s age could have been detrimental to the procedure, his health and activity level aided in the successful surgery, as well.
"He’s out there cutting down trees and farming," Keith says. "As soon as I saw him I knew he could handle it."
Batchelder’s first surgery was immediate and lasted a little more than eight hours. He’s had two more surgeries to remove dead tissue.
Keith is optimistic that the reattachment was a success, but says he’s not sure how much use Batchelder will get from the hand even after occupational therapy.
"We’ll start looking at rehabilitation and what kind of function he may get back," Keith says.
Batchelder isn’t concerned with the level of use he will get from his hand, he’s just glad to have it reattached.
"Anything that nature gives you is better than something that’s made by man," he says. "Even though I may not be able to use it as it used to be, I’ll be able to use it as it was meant to be."