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Maria: Foot and Leg Injury

The Accident

Early one morning in November 2014, Maria and her daughter were driving to a nearby casino in New York to celebrate their birthdays. About 35 miles north of their home in central Pennsylvania, they encountered heavy rains and hit black ice, causing Maria to lose control on the car. One of their tires blew and they collided with a 4-door truck.

Following impact, Maria, a registered nurse, knew she had to remain calm and had her daughter call 911.

“Something was wrong with my leg, I couldn’t move it,” she recalls. “My chest was in pain, and although my shoe was on, my right foot just didn’t look right” she said.

Emergency personnel arrived at the scene and transferred her to a nearby medical center.

The Path to UPMC

At the hospital, Maria was diagnosed with a broken sternum and several broken ribs. She also had extreme trauma to her legs.

“The skin was off from my mid-thigh to my calf, exposing my left ACL, and my right foot was detached from my leg. All of my bones were sticking out by my leg,” said Maria.

Hours had passed and Maria’s injuries were still exposed as doctors strategized a treatment plan.

“My husband asked that I be transferred to UPMC. I knew if I didn’t want to lose my leg, we had to go to Pittsburgh,” said Maria.

Hours continued to pass without any treatment to her leg. By late evening, Maria’s request was granted.

“Finally a nurse called for an orthopaedic doctor to evaluate me. The doctor told me the window of opportunity for him to save my leg was lost and I needed to be life-flighted to Pittsburgh.”

However, the weather had worsened and the Stat Med helicopter was unable to fly. Nearly ten hours after the accident, Maria was transported by ambulance to UPMC Presbyterian with her foot still detached.

Surgery and Recovery

Upon arrival at UPMC, Maria was admitted to trauma where Raquel Forsythe, MD, immediately called the UPMC Orthopaedic Trauma Surgeon, Ivan Tarkin, MD, and his team, which included Kevin Kang, MD.

“As soon as I arrived, they told me I had a 25% chance of keeping my foot,” said Maria. “I told them I need them to do whatever they had to, to save my foot.”

However, before she was able to have surgery on her leg, she needed a cat scan of her head. To add to her list of injuries, she was diagnosed with a brain bleed. Surgery on her leg could not performed until the bleed was under control.

Once the brain bleed was under control, Maria could undergo treatment on her leg.

“Dr. Kang approached me and said, ‘Maria you understand your circumstances – it’s not good.’”

As a nurse who stands on her feet for 12-hour shifts, Maria was not ready to accept that she might lose her leg.

“I begged Dr. Kang, ‘Please save my foot. I want to go back to nursing.’”

Early the next morning, Maria underwent her first surgery to stabilize her leg and ankle. Dr. Kang removed thousands of shattered pieces from her ankle, and stabilized it with external fixators. This process was done to alleviate some of the swelling and allow Dr. Tarkin to assess her condition and determine the best treatment plan for her injuries.

“I told Dr. Tarkin, I love my work. I live to work, please save my foot,” she recalls.

According to Dr. Tarkin, conventional surgery was not an option for Maria considering the mangled nature of her ankle injury– but, he still had a plan. Dr. Tarkin would perform a Retrograde Hindfoot Nail to salvage Maria’s foot. He believed this method would allow Maria to keep her foot and maintain her quality of life.

“He told me he would cut my leg above the break, and put a rod through my entire leg from my heel to my knee, fusing my ankle. I was told that the motion of my foot would be limited, but that I’d be able to walk,” said Maria.

“Because there was no meaningful way to restore what her normal anatomy was, and to get her large wound to heal - essentially her foot was hanging off - the only way I could accomplish those goals was to shorten her leg a little bit and fuse it to give her a rigid angle, knowing that over time she’d regain flexibility in the adjacent joints,” said Dr. Tarkin.

Unfortunately, a low blood count delayed Maria’s surgery further.

“All of my confidence was in Dr. Tarkin. He told me I was his patient, and that he’d be back in the morning to perform the surgery.”

The following morning, Dr. Tarkin used this unconventional method on Maria. The surgery required a collaborative team approach with the plastic surgery reconstructive service.

Following surgery and extensive rehab, Maria could return to most of her normal activities.

“By October, not even a full year later, I was back to working three 12 hour shifts. I have no pain. Dr. Takin listened to me. He saved my life.”

Maria's treatment and results may not be representative of all similar cases.

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