Last year, a terrible accident almost cost Dan Fibkins his life. It's the accident every lineman dreads: a dangerous repair during a terrible storm and contact with a high-voltage power line. It means electrocution, severe injury and, in the worst case, loss of life.
Mr. Fibkins, originally from Bayport, Long Island, says the electrocution knocked him unconscious and erased his memory of the most horrifying moments. The 33-year-old was living and working in Tampa, Florida, at the time.
"I was working on power lines during a lightning storm," he recalls. "A piece of equipment broke and energized the line. The line was in my hand, and they told me the electric current went through one hand and out the other. It passed through my body."
The pain would have been unbearable, so he was heavily sedated at the hospital. He spent three weeks in Intensive Care, while his wife, Tuesday, prayed for a miracle. They have two young children, Harry, age five, and George, 18 months.
After the accident, two miracles took place. The first one was that Mr. Fibkins survived. But the Florida doctors gave him devastating news. His hands were severely damaged up to his forearms, and amputation would be necessary.
"The plastic surgeon and hand specialist in Florida said, 'You'll need a miracle.' Dr. Michelle Carlson was it," Mr. Fibkins says. Michelle G. Carlson, MD, a hand surgeon at Hospital for Special Surgery, gave Mr. Fibkins hope after five doctors told him amputation was his only option. "The doctors told him he needed amputations because they did not see any way they could reconstruct all the loss of function that he had," Dr. Carlson explains.
Mr. Fibkins had known co-workers who needed their hands amputated after similar accidents. Yet despite his dire prognosis, he refused to give in. His wife, Tuesday, was by his side every step of the way. "She is one in a million," Mr. Fibkins says. Her father, whose colleague was head of a medical foundation in New York, suggested the Fibkins consult with top specialists in this area.
Several doctors in New York City concurred with the need to amputate. Then he met Dr. Carlson. After examining him, she thought long and hard about how she might be able to save his hands and restore function. "When she said there was something she could do, we were ecstatic," Mr. Fibkins said.
"Basically, the injury caused him to lose all the muscles, tendons, nerves, and skin from his mid-forearm to his fingers," Dr. Carlson explains. "It was basically like a huge 'shark bite,' leaving nothing but bone from his mid-forearm to the base of his fingers on the palm side of his arm."
To make matters worse, Mr. Fibkins had skin grafts from his thighs applied to his forearms in Florida, but they were infected and did not completely cover his wounds.
The first step was to eradicate the infection and make sure the skin grafts covered his injuries. A plastic surgeon was called in for the procedures.
Once the infection cleared up, Dr. Carlson could undertake the daring 10- to 11-hour operations she had conceived to try to save his hands. In February, she performed the first operation on his right hand and arm. Mr. Fibkins had the second operation to restore movement and function to his other hand in June.
The first step was a tendon transfer, which entails shifting a functioning tendon from its original attachment to a new one to restore action that has been lost. "I took tendons from his legs to reconstruct the missing muscles and tendons in his arms. I attached them in the forearm and then tunneled them under the grafted skin flaps to emerge in the palm and attach them to his fingers. This reconnected all the muscles in his arms to his fingers, so that his fingers could move."
Dr. Carlson also performed delicate microsurgery (under a microscope) to transplant nerves to restore sensation to his fingers. "There are basically two nerves to the fingers," she explains. "One nerve was not salvageable, so I used it to graft the other nerve. I harvested the unsalvageable nerve from the elbow to the shoulder, and then used it to reconstruct the remaining nerve."
It was one of the most challenging cases of Dr. Carlson's career. "It took a lot of 'creative' surgery and a lot of willpower and determination on the part of Mr. Fibkins and his wife to have a successful outcome," she says. "You won't find this in a medical textbook."
Tuesday Fibkins says she is grateful. "Dr. Carlson is a miracle-worker. We're so thankful we had her as Dan's doctor. Hospital for Special Surgery is in a league of its own."
Mr. Fibkins has already recovered some function in his hands and is able to hold various objects to perform activities of daily living. He can hold a cell phone to his ear, and a shampoo bottle, so he can wash his hair. Before the surgery, he had no ability to use his hands and was dependent on his wife, Tuesday, to do everything for him. "He's just amazing," she says. "I can't believe how well he compensates for the limited function in his hands. We don't look at what he can't do, we look at what he can do."
"He still needs one or two smaller procedures to fine-tune the previous surgeries and provide some additional 'pinch strength' to his thumbs," Dr. Carlson says. "His strength will continue to improve over the course of a year. Sensation in his fingers will probably take a year to return, as well."
Eventually, he should be able eat with a knife and fork, but will probably require some adaptive aids for certain activities, Dr. Carlson says. Mr. Fibkins says he's already figuring out creative ways to adapt, so he can use his hands. For now, he's happy he can put his arms around his children and hug them. And when sensation fully returns to his hands, he looks forward to holding their hands.