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Doctors 'replant' woman's arm with amazing results

"I'm not gonna give up. And hopefully this is a medical breakthrough and it saves lives and helps people."

Kelsey Ward nearly died about 10 months ago in a terrible accident as she was driving home.

But what happened since then has Kelsey now helping to make medical history.

That's because doctors at San Antonio Military Medical Center (SAMMC) on Fort Sam Houston tried something that's never been done before in Texas.

In fact, it's been done fewer than ten times across the country.

That's 're-planting' an arm that was severed above the elbow.

Replantation is the technical name for surgical reattachment, and the results in Kelsey's case continue amaze her doctors and rehab specialists at the Center for the Intrepid.

THE CRASH

"I left work and I really don't remember too much about the wreck."

Kelsey had left work at a north side restaurant early one morning, but doesn't even remember getting in the car.

So she's not sure what happened that caused her S-U-V to roll off an exit ramp and turn over.

That's when a metal guardrail punched through her passenger window and lopped off her right arm just below her shoulder.

She was left trapped inside and hanging upside down, with her seat belt still attached.

But after that, whatever could go right... did.

'LOOK FOR THE ARM'

San Antonio firefighters and paramedics arrived quickly and got right to work using tourniquets to keep her from bleeding to death while they raced to free her from the S-U-V.

"Then when we got her out of the car, that's when someone said y'all need to look for the arm," San Antonio Firefighter Ryan Dunivan remembers.

"We were walking around and I happened to see just her fingertips on the other side of the vehicle under the roof of the car. Then we got spreaders under there just enough to pull the arm out."

So they were able to get her severed arm on the ambulance with the rest of Kelsey just before it pulled away and headed for Fort Sam Houston and the Level One Trauma Center at SAMMC.

"I was the trauma surgeon on call that night." Dr. (Lt. Col.) Joe Alderete remembers getting the call at home.

"I do a lot of mass reconstruction oncology cases. And one of our chief residents said 'I think you're the only person that's crazy enough to do this.'"

But Dr. Alderete was reluctant, knowing the odds are incredibly slim for anyone to simply be a good candidate for arm replantation, let alone avoiding the infections and other complications during the many surgeries that would be needed.

"I was thinking there's absolutely no way. Most of the time these [accident victims] are crush injuries and not amenable to replantation.'

GUARDRAIL CUT 'LIKE A KNIFE'

But then he saw the pictures of exactly what the guardrail had done. And the 'good news' was that the metal had sliced fairly cleanly through Kelsey's arm, much like a knife.

That would make the severed tissue easier to reattach, though her severed arm had several broken bones and she had also suffered other injuries in the crash, including a broken pelvis.

"It becomes a decision based on how well her resuscitation has gone, whether or not she can physiologically withstand the initial operation, and then what the soft tissue is like," Dr. Alderete said.

And it all looked pretty good for Kelsey's chances for even attempting a replantation. But Dr. Alderete says it was still a very hard decision.

"Kelsey was asleep the whole time while we were resuscitating her, so the biggest thing is - 'Am I going to do something that could kill her?'"

"As I got her films and the digitalized images, I was looking at a sharply transected upper extremity so I said OK, mobilize the team."

THE TEAM

Alderete's massive team would include two vascular surgeons, a hand surgeon, another back-up hand surgeon and a plastic surgeon, along with many other SAMMC medical staffers.

"We were at one point - for the first ten hours of surgery - working on her at once. So just being able to bring the team together was incredible."

And at a military hospital, the lessons doctors learn in war are always top of mind.

"Absolutely, especially in massive combat casualties. We're used to dealing with massive teams in order to resuscitate somebody who's been blown up by a roadside bomb, saving as much tissue as humanly possible, and then facilitating reconstruction using kind of esoteric techniques."

To replant and rebuild Kelsey's arm, over the last nine months they've performed a series of surgeries, taking skin from one of her legs and deeper tissue from the other leg, which they used to help splice together major nerves.

MORE LESSONS FROM COMBAT

And they improvised, patching her broken, severed arm back together and back on.

But always in the back of their minds was - and still is - the backup plan. That's to take Kelsey's arm off again if any threatening complications should arise.

"If we're dealt a hand where either infection takes over or the vascular reconstruction didn't completely revascularize her arm, then we could definitely make a late determination for amputation down the road."

And while they were able to hook up Kelsey's ulnar nerve directly, they needed grafts for the median and radial nerves, and until the last few years, that wasn't a realistic option.

"But where we have moved forward so much in the last 15 years at war with so much catastrophic nerve injury, we've learned that biology is not only possible, but it's now mainstay."

And now nearly ten months after her arm was cut off, Kelsey is also a living case study in what's possible in rehabilitation, as she's working with experts at the Center for the Intrepid at Fort Sam Houston.

'WHAT WAS THAT?'

"We were sitting in the clinic and I saw Kelsey's elbow flex," Occupational Therapist Christopher Ebner remembers.
"And I said 'when did that start?' And she goes 'now.'"

"So for us that was an eye-opening experience because two-and-a-half to three months into a replant [like this] that's unheard of. There's nothing in the literature of somebody getting elbow motion back so soon."

"So from that day forward it was like we were constantly thinking two steps ahead. What do we need to start working on in order to facilitate her recovery?"

Ebner says they have 'McGyvered' some techniques, thinking outside the box by trying a kind of nerve sensor and stimulator designed for prosthetic patients.

"We have learned so much," Dr. Alderete says. "Specifically in Kelsey's case - what is possible in terms of nerve regeneration. It's completely helping us rearrange our thought process. How long do we wait before we either augment her nerve or allow some element to to teach her nerve to function?"

"And we're able to use a mild electric prosthesis to help continue her function and teaching her brain what her upper extremity is supposed to do."

S.A.F.D. FIRST RESPONDERS MADE IT POSSIBLE

Kelsey is now able to bend her elbow, with some movement of her hand and fingers. She can give you a unique, backhanded high-five, but the most impressive thing she can do is pushups.

Yes, real pushups. And she dropped down and did several on Tuesday at San Antonio Fire Station #48 as she visited some of the First Responders who saved her life. And her limb.

"We weren't expecting the arm to ever be reattached, honestly," Firefighter Robin Scibner admits. "We didn't even know what her prognosis was at that point."

But they were curious about what happened to her. And then shocked to find out how well she was doing when they first visited her last fall.

Her occupational therapist Christopher Ebner says it was the quick thinking of the First Responders who made the replantation even possible.

"Everything those guys did - the San Antonio Fire Department - was spot on. I don't think they could have done anything differently and her rescue and recovery was a direct result of the steps they took. That was the foundation of Kelsey's success that we're seeing right now."

Kelsey again thanked them for saving her life and admitted that she, too, is surprised at the speed of her recovery.

"I actually have a lot of use with my arm. More than I thought I was going to get at the nine-month mark. We actually didn't think we were going to see any movement for a year at all. Not even elbow movement."

'THERE'S A REASON GOD PICKED ME'

But doctors point out that Kelsey also happens to have a great attitude, which they say is another key to successful outcomes.

"You've got to be tough," Kelsey says of the ongoing pain of rehab work.

"It's worse than going through labor. It's the hardest, most difficult, most exhausting thing I've ever had to do. But I want my kids to know that there's nothing in this world that they're not capable of doing - and I'm living proof."

"I think there's a reason God picked me. I'm strong. And I want everybody to know that I'm not going to give up and hopefully this is a medical breakthrough and it saves lives and helps people."

If you happen to catch a glimpse of Kelsey's other arm, you might notice the tattoo - which she had put on a few months after the accident.

"It just says 'My story isn't over yet.' I wanted that because it was the most meaningful to me."

So stay tuned. We'll be following Kelsey's progress on News 4 San Antonio and here on News4SA.com.

And with bills mounting since her surgeries began, there's a go-fund-me page that's been set up to help her. You can reach that by clicking here: https://www.gofundme.com/2rptvd5w

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