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BAMC microvascular surgery program enables surgeons to save sawed-off thumb

By Elaine Sanchez | BAMC Public Affairs | Sept. 12, 2014

JBSA-FORT SAM HOUSTON — Homer Mora had the afternoon off so decided he'd check a "honey do" item off his list. Rodents had been getting into the trash on his ranch, so his plan was to build a trash can bin they couldn't breach. A seasoned woodworker, Mora headed out to his barn, switched on the table saw and got to work. Nearly finished, he reached down to get one last long board. He mistakenly lifted it at an angle and the board, along with his hand, got sucked into the spinning blade.

"It went in at a diagonal and cut every finger," recalled Mora, a county attorney from Falfurrias, a small town a few hours south of San Antonio. His ring finger fell to the floor and his thumb was cut so severely it was hanging on by the skin.

Mora raced into his house and asked his wife Virginia, a nurse by trade, to call an ambulance. As he struggled to remain calm, he wrapped a towel around his hand and went back to the barn to retrieve his ring finger.

Mora was first brought to a hospital in Corpus Christi, about 80 miles away. The doctors there took one look and referred him to Brooke Army Medical Center at Joint Base San Antonio-Fort Sam Houston, a Level I trauma center.

A few days earlier and Mora would have been diverted to another hospital, noted Air Force Maj. (Dr.) Peter Rhee, an orthopedic hand and microvascular surgeon. Fortunately, BAMC had just launched a formal microvascular surgery program to better serve military and civilian trauma patients throughout the region.

Microvascular surgery involves reconstruction of small arteries, veins and nerves under a microscope anywhere in the body and, as in Mora's case, re-implantation of a finger, hand or limb.

BAMC never lacked the specialty, Rhee explained, just the formal system that would enable them to receive patients through the trauma network.

"We saw a great opportunity to institute a service that would enable us to better care for our military and civilian trauma patients," he said. As a teaching hospital, the service also broadens the scope of training for residents, he added, skills that ultimately "translate to better care of our combat wounded downrange."

To institute the multidisciplinary program, Rhee and his colleagues, including Air Force Lt. Col. (Dr.) Jeremy Cannon, Lt. Col. (Dr.) Patrick Osborn and Lt. Col. (Dr.) Dmitry Tuder, gained buy-in from a number of hospital services, including the emergency department, intensive care units, operating rooms, orthopedics, trauma surgeons, plastic surgeons, nurses and technicians, and launched the on-call program in January.

Mora was their program's first patient. The surgery took 10 hours, with Rhee and Air Force Lt. Col. (Dr.) Joseph Gower peering into a two-sided microscope, carrying out the intricate reconnection of tiny blood vessels, bones, tendons, veins and arteries; then placing sutures that are finer than a strand of hair.

"It takes a steady hand to do this work," Gower noted.

Too much damage had been done to save Mora's ring finger, but the surgeons were able to preserve his little finger and thumb, a key concern since thumb loss impairs the entire limb. The little finger later proved too injured to be viable, but the thumb reconnection was a resounding success.

"With every surgery, there's an element of guarded optimism," Rhee said. "Depending on the damage, reconnection doesn't work every time. But if there's even a slight chance our patient will be more functional, it's definitely worth trying."

With the ability to work and drive, Mora said he's thrilled his surgeons took that chance.

"My thumb is a little shorter now, thanks to that saw, but it works and is getting stronger by the day," he said. "They did a marvelous job."

"We were treated with respect, courtesy and above all, care and concern," his wife, Virginia, added. "We are forever thankful and appreciative of everyone."

Among just five physicians at BAMC with the specialty, Rhee and Gower said their days have gotten busier since they launched the program, but the benefits gained are well worth it.

"We recently had a patient come in after getting her thumb almost amputated in a cake press," Gower recalled. "Within five hours of her hitting the door, we had re-established blood flow to her thumb.

"Being able to give someone the gift of a viable thumb or fingers ... it's very rewarding work," he said.