Complex hand, microvascular surgery lets trucker play guitar again

By Paul Snyder

By any measure, John Foisy is a fortunate man. In September 2019, while driving his truck to make a delivery in Atlanta, he was cut off by another driver, which caused Foisy to roll his truck. The impact of the roll on Foisy’s left arm – which had been dangling out the driver side window at the time of the accident – cost him his palm, nerves, blood vessels and arteries in the arm and severed almost everything down to the bone.

Two years later, the only thing missing from that arm is a pinky finger. Foisy, an avid guitar player, is able to play his instrument again and much of that’s due to the work of ASPS member and ACS Board of Regents Chair L. Scott Levin, MD, FACS.

Although Dr. Levin is proud of the result and particularly pleased that Foisy can again play guitar, he also sees a missed opportunity in the result.

“As plastic surgeons, our capabilities have come a long way,” Dr. Levin says. “When you consider the advances in microvascular surgery, peripheral nerve surgery, the surgical management of pain and vascular composite allografts, we’ve created a world of possibilities for patients. My criticism of this is that we have many venues and medical meetings where we could share this with other specialties in surgery and medicine – but we only seem to talk to each other.”

Immediately after the accident, emergency surgery at a Virginia hospital helped stop the bleeding and doctors were able to set Foisy’s broken fingers – although his pinky finger had to be amputated. However, his healing wasn’t progressing as hoped and doctors told Foisy that he would be lucky to be able to turn a doorknob again, let alone play a guitar.

About a month after the accident, Foisy went to Penn Orthoplastic Limb Salvage Center, where Dr. Levin set to

work on a series of procedures involving limb salvage, microvascular surgery and hand surgery to address the significant loss of skin, subcutaneous tissue, muscle and nerves in Foisy’s hand. Dr. Levin used flaps from Foisy’s upper arm to reconnect the blood supply to his hand.

A guitar player himself, Dr. Levin was sympathetic to Foisy’s desire to play again and actually instructed Foisy to bring his guitar with him so that he could understand the patient’s playing technique and get a better idea of how to conduct the microvascular and complex hand procedures to enable the greatest amount of range for Foisy’s left hand.

Dr. Levin’s work resurfaced Foisy’s palm and opened his thumb index web space using a lateral arm free flap, which

allowed the team to do reconstructive work on his nerves. All the while, Foisy was a committed patient in physical therapy, enduring sessions three times a week over eight months to gain movement in his fingers, hand and wrist. The entire time, he was reteaching himself how to play the guitar.

The outcome was successful – Foisy returned to Penn in May to play an intimate performance at the clinic for Dr. Levin and the other team members who helped in his recovery – but despite restoring form and function in his patient, Dr. Levin still says the outcome could have been better, had he been able to see Foisy sooner.

“He would have recovered more quickly – months sooner – and I would have been able to do more,” he says. “By the time he came here, his hand was already deformed with soft-tissue contractures that limited his motion.”

Dr. Levin insists the late referral came because many doctors in the medical field still don’t know the breadth of work that plastic surgeons can perform. Dr. Levin says he has colleagues across the country who can perform the kind of complex work that he does, but so many in the medical profession simply don’t know such options exist.

“We can talk about the perceptions of plastic surgery and how it immediately gets associated with aesthetic work and making people beautiful,” he says. “That’s not a knock – I’m all for aesthetic surgery and believe that as plastic surgeons, we have to strive for perfection with every patient we see. Aesthetic work is a hallmark of our specialty. But when we look at the innovations we’ve made, there seems to be the continuing problem of just showing them to one another. There are endocrinologists, vascular surgeons and even cardiologists who don’t understand what we do, and they need to know that because we can do more in these situations.”

Foisy’s story was recently featured in the Philadelphia Inquirer, and although Dr. Levin notes he does have patients referred to him from around the country and world, plastic surgeons need to continue to improve a dialogue with other specialties so the innovations and advancements made by the specialty are realized to their full potential.

“Without a concerted effort on that front, we’re only holding ourselves back,” he says.