Saving a Leg—Several Times Over
Gregory Rochester arrived at the Emergency Department at HackensackUMC Mountainside with precious little time to spare. The retired special needs teacher had been at home, tidying the house in preparation for the baptism reception of his youngest when he felt an alarming pain in his lower leg. “I had never felt anything like it,” he recalls. “When it didn’t go away, I knew this was something serious.”
Greg had a blood clot lodged in an artery behind his knee. The longer the muscle in his lower leg was deprived of oxygen the more tissue would die. “In a case like this, every minute matters,” says Dr. Raymond Holmes, the vascular surgeon who treated Greg. “His leg was certainly threatened.” Dr. Holmes used one of Greg’s veins to bypass the clot and restore blood flow.
But Greg wasn’t out of trouble yet. When blood is suddenly restored to muscle that has been deprived of oxygen, it immediately starts to swell. Pressure builds up in the muscle because the fascia, the sheath of tissue that encases it, doesn’t stretch. If the pressure is not relieved by making a series of length-wise incisions, the muscle will die and, in the process, produce toxins that cause kidney failure.
Dr. Holmes performed the fasciotomy, eliminating the next danger to Greg’s leg. It was up to Dr. Ross Zbar, a restorative plastic surgeon and head of the limb salvage team at HackensackUMC Mountainside, to complete the process. His role was to heal the wounds caused by the fasciotomy. “When I first saw Mr. Rochester, the muscle was protruding through gaps in his skin,” Dr. Zbar says. “In situations like this, our first step is to identify all the barriers to healing—no matter how small—and correct them.” These barriers can be medical issues like an infection or lifestyle issues like smoking.
Dr. Zbar also used a number of high-tech methods to jumpstart healing. This included a vacuum-assisted dressing that exerts negative pressure on a wound, helping it close, and hyperbaric oxygen therapy, which bathes the wound in high concentrations of oxygen. “Our approach is to assist the body to do what it is evolutionarily designed to do,” Dr. Zbar says.
When they met after the surgery, Dr. Zbar didn’t minimize the seriousness of Greg’s situation. He told Greg that he and his team would do the best they could, but they weren’t certain it would be enough. For his part, Greg appreciated his frankness. “Dr. Zbar is a straight shooter, which I feel is the way it should be,” Greg says. “In a situation like this, you want to know the facts.”
A month later, when Dr. Zbar told Greg that he had control of the wound, Greg felt he could breathe a sigh of relief. “If he said so, I knew I was on the road to recovery,” he says.
Three months after the operation, Greg’s leg has almost completely healed. He has regained most of his mobility, and Dr. Zbar believes the wounds will close on their own without a skin graft. “I’m very grateful,” Greg says simply.
Although Dr. Zbar points to new devices and new practices for making Greg’s recovery possible, he stresses that it takes a multidisciplinary team of highly trained, experienced professionals to use these procedures to their best advantage. “Wound care is complex,” he says. “At HackensackUMC Mountainside, we’ve brought together individuals who look at the patient as a whole, not through the lens of their own specialties, and who communicate and coordinate closely with each other.”