Medicine: Try for a Miracle

One sunny day last July, Mechanic Billy Smith, 25, went on the job to reline a steel furnace at the U.S. Pipe & Foundry Co. in Decoto, Calif., south of Oakland. Overhead a giant hook dangled from a traveling crane. In a freak accident, the hook crashed down on Billy Smith’s right leg and severed it just above the knee. For three hours and 35 minutes, Billy Smith’s leg was kept with his body only by a two-inch-wide ribbon of skin.

When Smith was brought into Eden Hospital in nearby Castro Valley, Dr. Stephen Landreth, 37, an orthopedic surgeon, prepared for a standard amputation. Then he had a thought: “This is too good a leg to throw away.” He got on the telephone to Dr. Alan Gathright, 38, a vascular surgeon, 20 miles away in Oakland. Asked Dr. Landreth: “You want to try for a miracle?” Gathright did, and he sped to the hospital.

What they attempted was nothing less than regrafting a severed limb to a trunk, although a successful operation after so long a time has never been recorded.* The conditions looked promising. The severed leg had been tipped up at an angle, and it was drained of blood; had blood remained, ruinous clots would have formed. The doctors’ first job was to restore the blood flow, thus restore some life to the limb. Before cleaning the leg fully, they stitched together the ends of the main artery, then the main vein. Quickly taking circulation from the trunk, the leg turned from a deathly grey to a normal pink. Then the surgeons cut away the crushed muscle and skin, shortened the bone by two inches (to make up for the lost tissue), sewed it up.

For a moment, it appeared that the heroic effort would fail. The leg went pale and lost its pulse. Dr. Gathright cut right back into the artery and removed a clot. Then an assistant pumped in an anticoagulant. There were no more clots.

Billy Smith’s leg, held by metal pins and skin grafts from his abdomen, has slowly knitted together during the past four months. He still has no feeling or movement in the limb. Not for another few months will the surgeons undertake thg. tricky task of reopening the leg to sew together the finger-thick sheath of the sciatic (spinal) nerve. They are going on surgeons’ experience that nerves mend better when they are connected several months after an accident, figure that Smith will start walking again—although with a severe limp—within a year.

At the least, Billy Smith now has a leg that is better than any store model. At best, the operation portends a technique that may save many a limb in the future.

* Soviet physicians have managed to graft the head of one dog onto the body of another dog.