Pink toenail polish
Then the fight began to save Kaitlyn’s feet.
Doctors at University of Louisville Hospital thought there was too much damage
to try replantation, but the Lasitters were determined to find a hospital that
would at least try.
“Double amputation was the easy way out, and we’ve never been the easy way out type of parents, and that’s why Kaitlyn is strong,” Monique said. “We just had to give her some kind of chance.”
Two other academic medical centers refused Kaitlyn’s case before a call came in to VMC’s Marc Tressler, D.O., assistant professor of Orthopaedics. Tressler told the
transfer center: “We can’t do any worse than what she has, so I’m up for trying to save her feet. Bring it on, I’m up for the challenge.”
“I took the doctor’s hat off and put the parent’s hat on,” Tressler said. “I’ve got two children of my own, and if one of my boys was in that situation and I
thought there was any chance in the world that they could have their feet back,
that’s what I would want. I understood the odds. I understood the unlikelihood of
either success or function, but that was the assumption that everyone else made and didn’t even bother to try.”
Once he accepted the case, Tressler assembled the team. Erika Mitchell, M.D.,
assistant professor of Orthopaedics, saw Tressler staring at the OR board and
asked what was going on.
“He said, ‘Well I just accepted this girl with bilateral foot amputations,’ and I just looked at him like ‘Are you crazy?’ We were both taken aback by it because it’s not something you’re used to dealing with,” Mitchell said. She knew the case would require two teams of surgeons and
offered to help.
Tressler also called in Doug Weikert, M.D., associate professor of
Ortho-paedics, who was not on call and enjoying a quiet dinner out with his
wife. After hearing the details, Weikert knew Kaitlyn was the perfect candidate
for replantation.
Kaitlyn was young enough to have the capacity to regenerate nerves. She was old
enough to be skeletally mature and remove the possibility of bone growth making
one leg longer than the other. And the 11-millimeter-wide wire cable had made a
remarkably clean slice just above the ankle. Injuries like this usually have a
wide zone of damage and the tissue is ripped and pulled, but Kaitlyn’s was like “somebody guillotined it off,” as Tressler vividly put it.
Despite these positive indications, the doctors still had a moment of hesitation
about replantation. Because the risk of infection and rejection is so high, it
can take months to know if the replantation is successful.
“Sometimes it’s actually better to have a prosthesis than have a foot that’s not functional or that’s painful,” Mitchell explained. “But at her age, you want to do everything you can to save her limb. I think you
try harder to make that work knowing full well that you may lose a year in
which she’s suffering with a bad limb and may ultimately end up with amputation anyway.”
All the doctors agreed they at least had to try, whether the surgery would be
successful or not, and Mitchell factored another intangible into her decision:
pink toenail polish.
“It would have been really hard to do nothing, looking at this child and her
disembodied feet with pink toenail polish on,” she explained. “I’ll never forget; it was a perfect pedicure. I could just imagine that she got it
done to go to the park and have this great time. I knew we just had to give her
all the care we could.”
The worst thing you can imagine
While waiting for Kaitlyn to arrive via helicopter, Tressler and Mitchell went
down the block to eat at Sportman’s Grille. They fueled their bodies for the long night of surgery ahead, fielded
phone calls and made arrangements for the surgery, and tried to catch details
about the accident on TV.
Kaitlyn touched down on the roof of Vanderbilt University Hospital around 11
p.m., six hours after her feet were severed. Standard practice says limbs
should be replanted within the six-hour mark. With the clock against them, the
team immediately went to work.
“I hope to never have to walk into a room like that again because you see a
little bit of your own kids in these patients,” Weikert said. “It’s just about the worst thing you can imagine to have to try to put yourself in a
position to help this poor girl who started out the day going to an amusement
park and ended up in an OR with both of her [feet] on the back table. It’s a pretty sobering experience.”
The first task is debridement, basically a good cleaning. All the surfaces must
be as clean as possible to prevent infection. Then Tressler and Mitchell each
took a foot and connected and stabilized the bone. Then Weikert led the team in
repairing an artery and vein in each foot to restore blood flow.
While the right foot immediately “pinked up” after it was replanted, the left foot was problematic. The falling cable had
also broken Kaitlyn’s femur, and the surgeons had difficulty getting blood flow past that injury and
down into her foot.
“We gave her blood thinner, we passed catheters up and down the blood vessel to
try to get rid of any clot or injury, and we actually did a couple of repairs
to the blood vessel just to see if we could stroke blood down, and after
probably four or five different ways to get blood, we just couldn’t achieve it,” Weikert said. Kaitlyn’s left leg was amputated below the knee the following day.
The all-night surgery took a physical and emotional toll on the physicians.
“I’ve been up operating plenty of nights, but the emotional toll of that suddenly
hit me that morning,” Mitchell said. “I just couldn’t imagine this poor girl just going for a day of fun and having something that
horrific happen. It was something I needed to sleep on, literally.”
