Clifford Barnes heard the news in April: He might lose his left leg
below the knee. The prospect was almost too much to bear for the
57-year-old triathlete, whose passion is competing in endurance
"It hit me really hard," he said.
Doctors at Stanford Hospital & Clinics had discovered that
Barnes' shinbone and the surrounding tissue had become infected as the
result of a compound fracture suffered months earlier. The injury had
left the Lodi resident with only one working artery in the lower half
of the leg. The combination of an infection and limited blood
circulation raised the specter of amputation. But James Chang,
MD, chief of the Plastic
and Reconstructive Surgery Division, and David
Lowenberg, MD, chief of the Orthopaedic
Trauma Service, had a plan to avoid that outcome.
They proposed removing the considerable portion of infected tissue and
bone just above the ankle, and then transplanting muscle from Barnes'
abdominal wall into the gaping wound. The operation would be
challenging; it would require connecting the intact leg artery to an
artery in the transplanted tissue — a procedure called end-to-side
vascular anastomosis — to ensure adequate blood perfusion.
Chang is one of the nation's top hand and microsurgeons, and
Lowenberg, an orthopaedic surgeon, one of the world's leading experts
in saving badly damaged limbs. Together with the hospital's other
plastic and orthopaedic surgeons, they have created a limb-salvage
program to apply the hospital's expertise to such cases. A team of six
microsurgeons are available at any time to perform these complex
"In my experience — and I've been doing
this for 22 years — we can usually get patients with these kinds of
injuries back to full activity," Lowenberg said.
Nevertheless, the surgeons would have to call upon their formidable
training and experience to make that happen.
Hit by two cars
Barnes' fateful journey to a Stanford operating table began almost a
year earlier, on June 26, 2010. It was a Saturday morning, and Barnes
was on his bike along State Highway 55, a two-lane road just outside
of Boise, Idaho. Barnes and his wife, Cathy, both former Idaho
residents, were visiting one of their daughters who still lived there.
As Barnes pedaled at roughly 20 miles per hour, an SUV clipped him and
sent him sprawling onto the pavement. A pick-up truck behind the SUV
then ran over both his legs.
"It all happened in the
blink of an eye,” Barnes said. "I was conscious. It felt like my
legs were lying on hot coals."
Both cars stopped,
and their drivers got out to help. One called 9-1-1, and an ambulance
soon was rushing him to a nearby medical center, where doctors cleaned
out the wound in his left leg and stabilized the fractures with an
external fixator, a device composed of rods and pins to immobilize
damaged bone. They also treated broken bones in his right leg. Back in
Lodi four weeks later, Barnes went to see a local orthopaedist, who
recommended Stanford Hospital. There, Lowenberg replaced the fixator
on Barnes' leg and continued to treat him. Healing of the wound
progressed, and in December of 2010 the fixator was removed.
"Life began to return to normal, but there was a small
spot, about the size of a dime, that wasn’t healing," Barnes
said. So Chang applied a skin graft to the lesion. A few weeks later,
on Easter Sunday, Barnes took a bike ride with one of his daughters.
When he got back home, he noticed that a blood blister had formed near
the edge of the graft.
He went to see Lowenberg, who
discovered the bone infection. It's possible that a small amount of
bacteria was still present from the original accident, Chang said. The
tiny aperture next to the graft, where the blood blister had formed,
was how the infection was getting oxygen to sustain itself.
Lowenberg and Chang devised a plan to eliminate the infection
and use Barnes' own transplanted tissue to salvage the leg. Barnes
agreed to the strategy, but he had one concern: His daughter's wedding
was in a matter of weeks; he wanted to be there. "I wasn't sure
if I was going to make it," Barnes said.
operated first to remove infected leg tissue and bone, packing the
wound with antibiotic beads. "The doctors helped me get to that
wedding," Barnes said. "I thought I would be confined to a
wheelchair, but they actually got me up on crutches for
Then on May 23 — two days after the wedding —
Chang spent nearly seven hours performing the tissue transplant, with
To cheer up Barnes while he was recovering from the surgery, Chang, a
recreational cyclist, told him that they would both ride their road
bikes to the coast — through Woodside and past Skyline Boulevard, then
down to Highway 1 — once he was better. "His eyes lit up, and he
said, 'That would be awesome,'" Chang recalled.
Today, Barnes' wound has healed. There is a slight bump where the
transplant has merged with the rest of the leg tissue. The bump will
grow smaller over time, and Barnes is back on his Scott road bike
again, logging as much as 300 miles a week and swimming. He recently
started to run again, too, and is planning to compete in a short
triathlon in June or July. In August, he plans to compete in an
Aquabike race — an endurance competition with swimming and cycling
stages — in the Lake Tahoe area. In 2013, he hopes to compete in the
Ironman World Championship in Hawaii.
Chang said he is
both looking forward to — and feeling somewhat apprehensive about —
his planned bike ride this spring with the veteran Ironman competitor.
But Barnes said Chang has nothing to worry about; he'll take it down a
few notches so that the surgeon can keep up.
tell people what the Stanford doctors were able to do, they are just
astounded," Barnes said. "I feel blessed to have been able
to get Dr. Lowenberg and Dr. Chang. They and the nurses — I can't say
enough good things about the nursing staff — are like family to us."
By John Sanford