(no audio) (upbeat music) (bright upbeat music) - "Eye on Education," I'm Fred Martino.

In 2022, Dr. Tim Daugherty joined the faculty at the Institute for Plastic Surgery at SIU Medicine, in Springfield.

And in September, not long after he started, he got an emergency call about a farming accident nearby.

We're going to talk with Dr. Daugherty coming up about that.

But first, the amazing story from the SIU School of Medicine.

This report contains actual video from surgery, so viewer discretion is advised.

(no audio) - It was, it was actually raining that morning.

So we weren't out there till about noon.

Things were running smooth.

- I just returned from Baltimore, Maryland, where I did my fellowship in hand and microvascular surgery at the Curtis National Hand Center.

And I was on call the first weekend that I had started.

- Once we bring the crop or the silage in that's all chopped up, we dump it from, our wagon has a conveyor belt in it, and it basically pulls it out, dumps it into another machine that grinds it even more fine and shoots it up this gets sucked up through about a 12 inch wide aluminum piping that goes over the side of the harvest store where they store the feed.

The blower was clogged, so we unclogged it.

We had to take everything apart, and as the PTO was winding down, I'm the young guy, so they have me go to the top of the harvester to make sure that the top chute that goes over the top isn't clogged.

So I got the ladder, and upon handing the ladder through to them, kinda looked down to make sure I wasn't gonna catch my foot on anything.

And just while I was looking, at the same time it all just kind of happened real quick, I was tripping.

And then put my hand down just to natural instinct of falling.

And when it happened, it was pretty surreal.

But, I just had to collect myself and kind of really assess what was going on.

We all acted so quick, we didn't really get to see kind of how and assess what did it.

So we got it wrapped up in towels and got water, got the fingers on ice immediately, because we were by my sister's house.

Had we not, I don't think this would, any of this would be possible.

Jumped into my boss's truck and then he had to drive me to the hospital in Jacksonville.

- When I got the initial call from Jacksonville Memorial Hospital, the emergency department physician sent me photographs of what his injury was.

The fingers were very mangled, but they were all amputated as one piece.

I immediately started planning what I was going to be able to offer for him and the ways that I could get him to restore normal anatomy and normal function.

I told them that time is of the essence.

I had him life flighted over to Springfield with the amputated peace on ice, because I wanted it to be well preserved for any microsurgical intervention.

- I mean, I remember the helicopter ride.

I was talking to him just normally, having a normal conversation, and it felt like a long dang helicopter ride at that point, probably an hour and a half after the accident.

- And obviously it was a very devastating injury and it's a very difficult thing for a patient to be able to take in that much information when they're undergoing something as devastating as he did.

But fortunately he was there with his sister and his mother, who were both able to understand what I was telling them and knew that there was a good possibility that he might wake up from surgery with his fingers on his other side, all with the goal of preserving them for later re-plantation.

- I vaguely remember Tim before the surgery.

I just remember he said they were gonna take good care of me.

- I was very happy with how the first surgery went.

We were able to repair all of the structures within the hand.

I tagged everything, including the tendons, the nerves, for later identification down in subsequent surgeries.

Enhanced surgery, you always have to be thinking of what is your next step?

And that's exactly what I did with ectopic banking, I'm always thinking about what is the next thing that I can offer him in order to get him to where he and I both want him to end up - Because I don't have feeling in it as far as touch or heat.

Pretty much anything 'cause it's just secured into the bone.

The nerves aren't attached yet.

So I can feel it sometimes when the doctor comes in to bend my knuckles.

They bend the hand to keep it supple or movable.

'Cause they don't want the joints to get too stiff, and that's just makes it harder for me to start bending my fingers as soon as possible.

He comes in here and gives her a couple good twists, and usually feel that a little bit in my radius bone, just 'cause you feel the pressure, doesn't last too long, and other than that, it's not bad.

- He had some tissue on his thumb that was devitalized and that was in need of partial amputation of the tip of the thumb.

And I had previously done coverage of the amputation site with a free flap from the groin.

So I planned to do an amputation of the portion of the thumb, rotate that flap to cover the tip of the thumb as well as to line the first web space, so that he could get his thumb out for gripping items.

And then I prepared the metacarpal bones for osteosynthesis for repair of the bone.

And then went over to the other side.

I raised the fingers that I previously had ectopically banked.

I raised them with some additional skin based off of the radial artery, and then I dissected back to the radial artery and lifted the fingers based off of that.

When we moved the hand over to the other side, we had to hook it up with microsurgery.

We use a microscope in the operating room that can zoom in to 30 times what we can see.

We use a small thread, the size of a hair to perform the anastomosis of the blood vessel in order to give the hand and fingers blood supply when we move it over to the other side.

I designed the flap in order to move the fingers over.

I took additional skin from the dorsal part of the forearm and the volar part of the wrist.

This additional skin gave me the ability to, when I moved the fingers over, to get them into a good position that will allow him to flex and extend the fingers and to close the wound primarily without needing any other tissue in order to do so.

Allowing the fingers to sit over on the forearm for the six weeks gave me the ability for blood vessel ingrowth into the fingers in order to do that.

My plan after that is to just allow the soft tissue to heal and allow the bones to heal, have him work on a finger range of motion, which will require a lot of hand therapy in order to do that.

Fortunately, we have very well-trained hand therapists here in our office that will be able to work with him on a weekly basis multiple times a week in order to maintain his joints in a supple condition for later reconstruction as needed.

Ben will need future surgeries down the line.

He will need reconstruction of the nerves.

It would've been too risky to do this at the time of this last operation.

And my main goal for that would've been, would be that his fingers were alive and healing.

So I will plan to take him back to surgery at a later time to do reconstruction of the nerves and reinsertion of a few of the tendons.

But in the meantime, with the goal of keeping his joints supple, the next mainstay of his treatment will be a lot of hand therapy in order to get to where we both, he and I want him to be.

My hopes for Ben are to regain function, to regain the dexterity of his fingers and sensation, which is the primary thing that a prosthetic will not be able to give you.

- What I'm looking forward to doing most when I get outta here is getting back to my normal routine.

Can't believe I'd ever complain, I pray that I won't ever again, just the small things.

Getting out, being able to feed my cattle and water them, not having to seeing it more as a get to, 'cause that's- It can all be changed really very, very, very fast.

(bright upbeat music) - And joining me now in studio for us from Springfield, Dr. Tim Daugherty from the Institute for Plastic Surgery at SIU Medicine, Doctor thank you so much for being with us.

- My pleasure.

- Good to have you here today.

Well, we are taping this about a year after the farming accident described in the video.

So to start off with, how is Ben doing now?

- He's doing very well.

So as far as function goes, he has ability to pinch his index to his thumb, and so he's doing some things around the farm and around home, and he will have surgeries down the line.

And he's scheduled for one here shortly.

And the main purpose of that is then to do secondary reconstruction for the remaining digits and for sensory, for sensation to his fingertips.

- That must be incredibly rewarding to see him now after what we saw in that video.

- It is, and every time down the line I kind of have a conversation with him about are you happy that we did this, or is there anything else that I can do for you to get you where you want to be?

And every step of the way he is on board and is happy that we've gone this route.

- Well, you mentioned in the video that you had just returned from a fellowship at the Curtis National Hand Center in Baltimore.

What were you thinking, learning that your training would be tested so quickly?

Tell me about that.

- Well, I've been fortunate to train at some of the best places in the country for hand surgery.

You know, one is SIU it's very well known for hand surgery.

And then secondary to that, Curtis National Hand Center for my fellowship, and we did several cases of ectopic banking during my time there and I got a large exposure to trauma, and it's always been something that I've loved with hand surgery is a restoration of function after bad traumatic injuries.

And so I was, as soon as I got the photos from the outside hospital I was- I felt well, now's the time.

I was passed on it rather early, but excited to get started.

- I imagine, tell me about the fellowship, how you were trained.

- So we are trained in all aspects of hand surgery.

I also, I did a lot of work obviously at Curtis, but then part of my fellowship was also at Johns Hopkins doing peripheral nerve surgery.

And so as part of fellowship we get trained on all aspects of hand surgery and trauma is sort of bread and butter training for us as part of fellowship.

So learning how to reconstruct the hand after these bad traumatic injuries.

- So do you work in the training?

Do you work on models that will replicate what a surgery would be like?

- Typically a lot of it at that stage, you know we've already gone through residency, we're already comfortable operating, so it's usually on people dealing with the different traumatic random events that come to your fellowship year.

But we also do a lot of work on cadavers as well, simulations as to different types of surgeries, different reconstructive options for coverage.

And if we're toying and playing with different implants, we might try it on a cadaver first before we're doing it live on a person.

- Doctor, I imagine you have people tell you this from time to time.

When I watched this video, it was really amazing to me to see the advancement in surgery and the kind of work that is being done.

But at the same time I thought, I am in awe of the decision to seek the ability to do this kind of of work.

It's very, it would be very, I think, intimidating to a lot of people to think about doing this.

Tell me about your decision and your interest in this type of surgery - In specifically reconstructive hand surgery?

- Yeah, yeah, I mean, because it's such a- Watching this, that is what I think people may take away is, this is quite an amazing thing, but at the same time, the training, the things that could go wrong.

I'm sure there are many things that could go wrong and I'm wanting to get into that in your decision making and saying, I want to do this.

- Yeah, so as far as choosing a specialty, plastic surgery wasn't really on my radar when I came to medical school, and it wasn't really until I had rotated through it and saw all the amazing things that you can do with it, other than what the standard person thinks of when they think of plastic surgery.

A lot of what we do is focused on reconstruction.

And I find that to be very rewarding and almost a little bit less anxiety provoking, because I kind of go into it thinking, I can only help this person.

There's very little that I can do to hurt them more than they've already been hurt.

And so that's one reason I really liked it, is I feel like I can really give them something that's to improve their life and their quality of life.

And then when I was working in plastic surgery and was able to see the different types of reconstruction and specifically hand, I mean people don't really realize how important their hands are until they're injured.

And so really being able to give that back to somebody, in my opinion is incredible.

- It certainly is incredible, and I've never seen anything like this before.

I'm guessing many people who watched the video, it was the first time that they had seen something like this.

How long have we been able to do a surgery like this?

This kind of extensive reconstruction?

- So we've been able to do microsurgery, so like saving fingers or replanting hands, probably for about 30 years around that amount of time.

And a lot of the innovation there has been, creating instruments and creating a microscope that's fine enough to to zoom in and see those really fine structures.

Because when you're repairing a blood vessel in the hand or a nerve in the hand, those are a millimeter, maybe two, and so you really need something that can really allow you to focus in and see those fine structures.

And then a lot of the innovation beyond there, such as cases like this with ectopic banking, that's been kind of something that was probably developed around the '90s, 2000s.

And the whole thought process was that if a piece of tissue is too damaged to be able to put back on at the time, then we can basically save it by giving it its blood supply and then go and move it later.

And in this case, the patient's hand had been kind of multi-level injury, the tendons had been torn off, there was tissue missing, skin coverage missing from the hand itself.

So putting it back on, on the injured hand at the time, it probably, the tendons would've been so stuck that they wouldn't have moved again.

And so that was the idea of putting it on the other side to save it temporarily until we had good coverage and until we could go back in and move those tendons at a time that I could rehab them so they wouldn't get stuck.

- I don't believe that the video mentions how long the surgery lasted.

How long was it?

- I believe his, so he had multiple surgeries in the hospital.

The original one I think was about eight hours.

And then the surgery that we did to move the hand back over was probably around the same time, eight to 10 hours.

- That's what I thought, because I've read a little bit about this, of course, getting ready to talk to you today.

And that is another aspect of this that is just amazing to me, to be in surgery for surgery for eight to 10 hours.

Tell me about the mental and the physical preparation for a surgery like this.

- So mentally, I think about my patients quite in detail and I usually kind of run a game plan through my head prior to execution in the operating room.

And that's kind of what keeps me going.

I have a clear plan as to what I'm going to do, and then beyond that it's just the execution.

But just making sure that I have everything that I need lined up prior to getting to the operating room.

And physically, I try to do everything normal, the same thing that I do every day, the same amount of coffee, just to have have the energy to get through the day.

But I really, I usually don't take any breaks, but you know certainly you can step out, use the restroom, have some meal if you need to, but I typically just power through and I'm kind of so mentally engulfed in the surgery that I just kind of see it to the finish line.

- Yeah.

Tell me about the importance of technology in doing this type of surgery.

I'm sure it can't be done just anywhere.

There are probably limited facilities to do this kind of work.

- Yeah, there definitely are.

Your limitations are basically, having the ability- Having a microscope that can zoom into the power that you need to do this.

Certainly to have the technical, the staff, and the people to support you that have all the instruments and everything that you need.

And it's definitely a more specialized field that you don't see in every hospital.

- Well, certainly, I mean, when I watched this that was another emotion that I had, which was that I am so grateful that the facility is there to provide the service.

That there are doctors like you who want to do this kind of work, who learn how to do this kind of work, because, while certainly this was an occupational accident, this kind of injury can happen to any of us in a car accident, that kind of thing.

And I have personally known people who've been in catastrophic accidents in the car where reconstruction was a big part of their recovery and their healing.

- Yeah, we certainly see people from all, different states surrounding us, we see- I've personally seen people from Kentucky, Tennessee, Missouri, Wisconsin, Michigan.

So I mean, you definitely get a large area that we serve for some of these specialized traumatic injuries.

And it is just more,- There's a lot of different mechanisms throughout life people use their hands constantly, so there's a lot of different ways to get them injured.

And motor vehicle collisions are certainly very common and fireworks, snowblowers, different things that have risk associated with them, not just manual laborers who are using their hands or farming accidents, things like that, we see all sorts of things.

- Yeah.

Well, I've asked you some very specific questions but I wanted to, in our final time here together to to give you a chance for anything that you really want people to know about your job and this very complicated surgery?

- So I think just in general, I just think to know that, there's always options for people.

If certainly reconstruction, a lot of the work that I do with peripheral nerve surgery, spine surgery, people who have had spinal cord injuries specifically, a lot of times they think, okay, well this is just how I am, there's no options for me.

So I think that just being your own advocate and asking, or at least if nothing else, a consultation just to see, hey, is there anything else that I can do to improve my upper extremity function?

I think that that would be the main takeaway.

- Well, certainly, as I said, Doctor, I'm very grateful for the work that you do, and very grateful that you spent some time with us today to share it with a wider audience so that people understand that this service is available, and we appreciate it so much.

- Absolutely, happy to be here.

- Good to have you with us.

That is "Eye on Education" for this week, I'm Fred Martino.

Thank you so much for being with us today.

Have a good week.

(upbeat music)