BitDepth 639 - August 04

Adrian Foncette’s recovery from the kind of limb injury that normally ends in amputation speaks to the potential of science to change lives.
Healing hands

Adrian Foncette in training with San Juan Jabloteh in July. Photography by Mark Lyndersay.

Life was good for Adrian Foncette.
He was following his family’s tradition as a footballer and his talent as a goalkeeper was beginning to blossom. Just off a run with the National Under 20 team, he was in training to play with the Under 23 team in May 2007 after a long run playing competitively between the bars in secondary school for Fatima College.
Then everything came to a screeching, slamming halt. 
Just a minute away from home, travelling back from the gym and planning his training day the next morning, a van broke the major road and slammed into the taxi he was travelling in.

Foncette’s arm was on the door window when the van slammed into it, and the  resulting wound was large and filthy and there was a real threat of gangrene setting in.
Dr Fayard Mohammed first saw Foncette during surgery being performed on the damaged arm. Orthopaedic surgeon Dr Marlon Mencia called on Mohammed for his advice on covering the wound.
The team employed Vacuum Assisted Closure, a powerful suction device that cleans the wound thoroughly and allows for airtight dressing of the wound.

Another surgical procedure grafted a large strip of skin, roughly six by four inches, from his thigh to cover the wound, a massive gouge extending from his elbow to midway down his arm.
At this point, the Adrian Foncette case had reached an impasse. Surgery had saved his hand, but muscle had been lost, along with articulation.
The case was presented to Dr Alejandro Badia of Florida’s Badia Hand to Shoulder Center and tendon transfer was planned.
Dr Badia has a history of working with athletes and returning them to the field of play, and his work includes surgeries on Indian tennis ace Sania Mirza and Barbadian golfer Sean Edey.

Returning mobility to Foncette’s arm required transferring the attachment points of muscles that survived the crushing accident to take the place of muscle that had been lost.
It took five surgeries to transfer the tendon attachment points and four months later, additional surgery to reshape an unsightly indentation in the arm.
Dr Badia is pleased with the outcome. “It is an exceptional result: a combination of technically precise surgery, diligent therapy and a motivated young athlete with good family and community support,” he wrote in response to an e-mail query.

Foncette, a gangling, shy young man with a winning smile, says his arm feels the same now as it was before his accident.
“At first I was scared to play, the injury was close to the bone and I’d be worried that it would get hit,” Foncette said.
By December 2007, young Foncette was feeling confident enough in his recovering limb to begin playing again, but he wouldn’t begin full training again until May, a year after the crash.

But his youthful exuberance would pay off. In December, football scouts saw him play and offered him a scholarship at the University of Albany. The young goalkeeper, currently in training with San Juan Jabloteh, will leave in mid-August to continue his career.

Tendon transfers are done locally, but successfully healing limbs requires the efforts of a substantial team, beginning with the initial trauma treatment through to the extended physiotherapy needed post-operation.
“Locally, the public system lacks the time and infrastructure for many of the super-specialties such as hand surgery, which hopefully will someday be addressed,” notes Dr Fayard Mohammed.
“Hand injuries are lumped in with all other trauma and cancers and not given a priority (life before limb) leading to frequent disability that is preventable.”
Local orthopaedic surgeon Godfrey Araujo and physiotherapist Lisa Niles are working to improve the situation by forging links with Miami based Baptist Health to deepen the knowledge base of Trinidad and Tobago’s limb recovery specialists.
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