Surgeons surmise outcome of alligator victim's treatment

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Surgeons surmise outcome of alligator victim's treatment

By PATRICK DONOHUE pdonohue@beaufortgazette.com 843-706-8152
Published Friday, October 16, 2009   |  634 Words  |  news

Surgeons say it is unlikely doctors at the Medical University of South Carolina in Charleston successfully reattached the arm of a 77-year-old Ohio man attacked by an alligator last week while playing golf on Fripp Island.
The patient's age and the extent of his injury suggest he would not be able to regain function in the limb.
"The problem with animal bites is that you have a lot of soft-tissue loss," said Hilton Head Island surgeon Dr. Joseph Tobin. "Sticking someone's arm back on, in this day and age, is not that big of a deal, but you're worried about infection, you're worried about how it's going to heal and you're worried about nerve regeneration."
Savannah television station WTOC last week identified the golfer as James Wiencek, father of a Fripp Island property owner. Fripp Island officials confirmed Wiencek was taken to MUSC, but the hospital said it will not release any information on his condition at the family's request.
Several attempts to reach Wiencek's son were unsuccessful.
Witnesses say the elder Wiencek was playing Oct. 8 on Fripp's Ocean Creek Golf Course and knelt down to pick up his ball near a pond on the 11th hole when a 10-foot, 400-pound alligator attacked him. Wiencek was dragged into the pond and lost his arm below the elbow in the struggle. The arm was recovered from the alligator's stomach about an hour and a half after the attack.
Although details of Wiencek's injuries have not been disclosed, four orthopedic and transplant surgeons contacted this week said that based upon the facts available, doctors likely faced several obstacles if they attempted to reattach the limb.
First, doctors would have made sure Wiencek was stable before even considering reattachment, said Dr. Linda Cendales, an assistant professor of surgery at Emory University in Atlanta.
"It's life over limb," Cendales said. "You want to make sure the patient is OK and that the patient is stabilized. Then, you have to look at the condition of what remains of the arm and the condition of the amputated arm itself."
If they decided to operate, doctors would have about four to six hours to restore blood flow to the lower arm, said Dr. Gary McGillivary, an orthopedic surgeon at Emory.
"The problem with an injury like this is that you have a lot of muscle in that part of your arm, and if you don't have blood flow to those muscles, they start to die very quickly," McGillivary said.
If the arm was reattached, the surgeons all said that infection from the alligator's mouth and digestive system would be a serious concern.
"There are certainly a whole host of bacterial contaminants that could cause very severe infections," said Dr. Jeffrey Fried, the chairman of orthopedic surgery at the Medical Center of Central Georgia in Macon, Ga. "The clock is ticking as soon as the arm is severed."
Given Wiencek's age, Tobin said the man might not have benefited from getting his arm back.
"The question you have to ask yourself is what will you have when you're done," Tobin said. "If you give someone back a stiff, painful limb, you haven't done them a whole lot of favors. In the long run, he's probably going to be functionally better off with a well-fitting prosthesis."
"It's never normal again," McGillivary said of the reattached arm. "You have a much better chance of reattaching a hand. As you get closer to the shoulder, your chance of success gets lower."
Cendales said it is likely doctors opted not to reattach the limb, but instead cleaned the wound for several days, put Wiencek on a regiment of strong antibiotics to prevent infection and ultimately closed the wound.