Hand Wound Nearly Costs One Patient his Limb (and his Life)

How Parkland Health Center and Barnes-Jewish Hospital Helped Save Him

On December 30, 2022, Tony Myers, 58, of Farmington, Mo., suddenly began feeling ill while at work. He had a fever, chills, fatigue, and body aches. Given that it was the height of cold and flu season, he assumed it was a respiratory infection or possibly the flu, so he headed home and went to bed hoping a good night’s sleep might help. However, when he awoke on December 31, he noticed his right hand – which had been a little itchy after sustaining a small cut – had swollen significantly.

“In addition to the swelling, there was some pus around the wound, which looked concerning,” said Myers. “That’s when I told my wife, DeDe, we needed to go to the hospital.”

Just a short drive from their home, Myers and his wife arrived at Parkland Health Center’s emergency department. Although it was rather busy, the emergency team quickly checked Myers in and began to work to address the infection on his hand.

When a Minor Cut becomes a Major Infection

“When Tony first arrived, his hand was very red and swollen. The swelling was going up his arm and passed several joints from where the swelling originally started,” said Shaylyn Emanuel, RN, an emergency nurse at Parkland Health Center. “In fact, it was so swollen that he was having trouble making a fist. This was one of the first signs that something more serious was going on.”

Myers disclosed that he was on immunosuppressive medication for rheumatoid arthritis, and that he has a penicillin allergy. The team then ordered blood work to assess the level of infection and determine which type of antibiotic they could give him.

“Tony’s white blood cells were extremely elevated, which further indicated that his body was fighting a much bigger infection,” said Emanuel. “We knew we needed to get a hand specialist involved quickly in order to have the best chance to save Tony’s hand.”

Recognizing the Need for Advanced Treatment

Matt Akers, NP, a nurse practitioner in the Emergency Department at Parkland Health Center, immediately contacted Mitchell A. Pet, MD, the director of hand and upper extremity surgery within Washington University’s Division of and Plastic and Reconstructive Surgery at Barnes-Jewish Hospital, who is also fellowship-trained in treating the most serious hand conditions. As part of BJC HealthCare – one of the largest nonprofit health care organizations in the U.S. – Parkland Health Center receives support from and access to BJC specialists and advanced medical services whenever needed. Parkland Health Center’s Emergency Department effectively evaluates, cares for, treats, and when necessary, transfers patients who require more advanced treatment.

“Although we knew Tony would require more advanced care, we went ahead and initiated strong intravenous antibiotics in an effort to begin treating the obviously severe infection,” said Akers.

After hearing the details of Myers’ infection and learning he was immunosuppressed, Dr. Pet agreed with the emergency team and recommended an emergency transfer to Barnes-Jewish Hospital via ambulance. By the time the ambulance arrived at the Barnes-Jewish, Myers’ hand had increasing redness, with some tissue beginning to show signs of necrosis tissue necrosis. He was quickly taken to the critical care wing of the emergency department where he met with Dr. Pet, who immediately recognized Myers’ infection as a severe case of necrotizing fasciitis (NF).

“When they transferred me to Barnes-Jewish Hospital, I figured my hand infection must be pretty bad,” said Myers. “But it never occurred to me that it could be limb-threatening or even life-threatening until Dr. Pet explained what I was up against.”

What is Necrotizing Fasciitis?

Necrotizing fasciitis (NF), also sometimes called a flesh-eating bacterial infection, is a bacterial infection that spreads suddenly and rapidly, destroying parts of the body’s soft tissue. The infection typically enters the body through a break in the skin such as a cut or burn. The extremities, such as the hands and arms, are the most commonly affected areas. Symptoms often include red or purple skin in the affected area, swelling, severe pain, and fever. 

“Tony’s infection was particularly severe in nature with several tell-tale signs of NF, including redness, pus that was thin and watery, as well as gray, dead fascia and connective tissue,” said Dr. Pet.

NF is extremely rare – affecting 0.4 people per 100,000 in the U.S. every year – often striking those who are immunocompromised, and those with other contributing conditions such as diabetes, cancer, obesity, or peripheral artery disease. The key with NF is to diagnose and treat it as quickly as possible with antibiotics and surgical removal of the infected tissue to stop the spreading tissue necrosis.  However, even with high-quality treatment, the risk of death is still between 25 and 35 percent, and delays in surgery are associated with a much higher risk of death.

“Given the extent of Tony’s infection, I didn’t know if we’d be able to save his hand and arm, and quite frankly, my primary goal was to save his life,” said Dr. Pet. “I candidly explained that we’d need to remove all the dead tissue to stop the NF from spreading. Therefore, I would need to cut away any necrotic tissue until I could see only healthy tissue remaining.”

Multiple Debridement Surgeries Followed by Reconstruction

Myers was rushed into surgery at  Barnes-Jewish Hospital on New Year’s Eve, where Dr. Pet worked to debride the wound, which means to remove any tissue that was dead and/or infected. Within the next 24 to 48 hours, Dr. Pet continued to monitor Myers, who had some early improvement but then showed signs of ongoing infection spreading further up his arm. Myers was taken back to the operating room for a second debridement which was even more extensive than the first.

After assessing Myers, Dr. Pet scheduled him for a third surgical debridement procedure on January 5, 2023. He wanted to ensure that the NF infection was finally cleared.

“This third debridement procedure confirmed that there was no more necrosis in Tony’s hand and arm,” said Dr. Pet. “That meant we had successfully cleared his hand and arm of infection and could now focus on the reconstruction process.”

For his fourth and final surgery, Myers would require a free flap surgery (also called free tissue transfer), which is a reconstructive surgery that transfers tissue from one area of the body to another. The flap is brought with a critical artery and vein, which are hooked up to vessels at the recipient site under a microscope, thereby ensuring blood flow to the transferred tissue.

“In Tony’s case, we transferred the latissimus dorsi muscle – known as the ‘lat’ – from the left side of his back to his right hand and arm,” said Dr. Pet. “This provided a large swath of pliable tissue that allowed us to reconstruct his hand and arm and cover his tendons and bones. We connected the transferred tissue to the radial artery and cephalic vein to ensure a healthy blood flow.”

Gratitude for the Medical Heroes who Saved his Hand and Life

Myers spent a total of 17 days at Barnes-Jewish Hospital, where he and his wife encountered numerous medical personnel who took extraordinary care of Myers. Several of his nurses – Remy, Julie, and Taylor – became more like family. Marissa Jensen even took time before and after her shift to visit Myers and his wife throughout his stay. Among the many doctors who took care of him, Dr. Pet and plastic surgery resident physicians, Drs. Shea Harrison, Jonah Orr, and Jordan Bruce, were particularly extraordinary in Myers’ eyes. That said, he extends his gratitude to the entire BJC team, from the ER, surgery, ICU, and specialty teams to the medical teams on floors 16 and 17.

“They are my heroes. Every single person I encountered on my care journey was so kind, thoughtful, capable, professional, knowledgeable, and great to me. Even the cleaning crew went above and beyond to ensure that my hospital room was clean, because they understood how vulnerable I was to potential bacterial infections,” said Myers. “I’m incredibly grateful to everyone who saved my life, limb, and hand function. There were so many other amazing health care professionals that helped us, and I just can’t remember all the names. But I’m a better person today and will benefit for the rest of my life because of them and this experience.”

Myers is also grateful to the emergency  team at Parkland Health Center for recognizing the seriousness of his hand infection that fateful night.

“I would’ve died if not for Parkland Health Center. That hospital is truly an asset to our local community,” said Myers. “The emergency team there recognized how serious my wound was. Their quick-thinking with initiating the blood work, administering antibiotics, contacting Dr. Pet, and transferring me to Barnes-Jewish played a major role in my outcome.”

Focusing on Healing and Restoring Full Use of his Hand

Myers was discharged from Barnes-Jewish under the care of a home health nurse and with the support of his wife. He sees Dr. Pet every few weeks to monitor his wound healing. Dr. Pet also referred Myers to a hand therapist for physical therapy two days a week.

Myers’ physical therapist helped him  increase his range of motion and function, as well as his grip strength. Grip strength is a measure of muscular strength, or the maximum force/tension generated by one’s forearm muscles. The average grip strength for a male Myers’ age is 100 lbs. His is currently at 48 lbs., but he continues to improve and, with time, hopes to get even higher.

Myers will likely need physical therapy through the end of the year; however, he is optimistic about his hand function continuing to improve. Dr. Pet is optimistic as well.

“Tony has made excellent progress with his physical therapy thanks in large part to his commitment to his recovery,” said Dr. Pet. “He has regained outstanding range of motion, and I expect he’ll soon return to all of his former activities and abilities.”

Finally, Myers wants to acknowledge the following family and friends, whose support and prayers fueled his positivity and determination to recover:

• His amazing and loving wife, Dede Myers
• His employer US Tool, company employees, and the HR team
• His bosses, Bruce Williams and Brent Williams
• His good friends, John and Melinda Brown, who drove Dede to Barnes-Jewish on New Year’s Eve and stayed with her while Myers was in surgery.
• Dr. Guy Roberts and his wife, Kelly Roberts, NP
• The Jensens, Bequettes, Harringtons, Trumans, and all his friends for their support.