Medicine: New Year’s Tale

A severed leg is rejoined

On the afternoon of New Year’s Eve, Elizabeth McFadden, 11, and her sister Alice, 12, were playing near their home in Central Islip, N.Y., when two youths accosted them, demanding money. Alice fled over some Long Island Rail Road tracks. Halfway across, Elizabeth saw a train bearing down on her, tried to turn back and stumbled. Her right leg was severed just above the knee by the wheels.

Elizabeth was more fortunate than most victims of such accidents. An off-duty ambulance volunteer, Vincent Cascio, who happened to be near by, ran over and used a belt as a tourniquet to stop the bleeding. Summoned by a radio cab, Police Sergeant Fred Muehling alertly retrieved the leg. Ambulance attendants carefully surrounded the severed limb with cold packs before rushing it and the girl to Smithtown General Hospital.

Because of Elizabeth’s youth and the relatively good condition of the wound and leg, a hastily assembled surgical team under Orthopedist Gerald Wertlieb decided to try to rejoin the limb. Though hundreds of amputated fingers, hands and arms have been reattached, such operations on the leg are quite rare, with most successes reported by the Chinese.

Wertlieb and Drs. Sultan Mohiuddin, Bruce Nadler and Michael Mamakos toiled for six hours. They removed damaged tissue from both stump and leg (including nearly 5 in. of bone), inserted a 15-in. stainless steel rod into the thigh bone as a support, then reconnected an artery and two veins. Heartened by the surgery’s initial success, an exultant Wertlieb said after the operation: “It was a New Year’s Eve high without a drink.”*

Still, the work could be undone by any number of complications, including a blood clot, infection or kidney damage. If the healing continues, the doctors will attempt to rejoin the leg’s severed nerve in a few months. Though they conceded that the chances of retaining the limb are only fifty-fifty, they were optimistic. So was Elizabeth, who basked in all the attention and even asked for a Big Mac.

*Perhaps inspired by publicity over the operation, a suspected Puerto Rican terrorist, whose hands were mangled in an explosion, last week sued New York authorities for $1.2 million. He accused the police of confiscating his fingers as evidence, rather than taking them to a hospital for reattachment.