MORGANTOWN, W.Va. – When 13-year-old Elijah Gibson-Holbert headed out for an evening ride on his dirt bike last August, he never expected his life would change by nightfall.
That evening, an accident involving a motor vehicle left the Uniontown, Pa., teenager with multiple severe injuries, including a traumatic open fracture in his lower left leg where the bones had broken through the skin.
As paramedics rushed Gibson-Holbert to WVU Medicine Golisano Children’s Hospital Emergency Department, he overheard a frightening word: amputation.
Shortly after he arrived, David Tager, M.D., pediatric orthopaedic surgeon, and Halil Safak Uygur, M.D., plastic and reconstructive surgeon, teamed up to assess his leg injury and to develop a coordinated surgical plan.
Gibson-Holbert had broken his femur, the large bone in his upper left leg, along with both bones in his lower left leg, the tibia and fibula. Multiple tendons, ligaments, and blood vessels in the lower leg were also damaged.
“In terms of extent of injury, this is probably one of the more severely injured legs that I’ve worked on in a kid,” Dr. Tager said.
To stabilize the injury, Tager applied an external fixator, securing the bone with pins and wires attached to an outer metal bar. Though this is a common procedure for major breaks, Tager noted that setting the tibia was especially challenging because the entire length of the bone had been exposed.
Tager also performed multiple surgeries to clean the wound and remove dead tissue. Eventually, he replaced the external fixators with internal rods.
“He had like seven or eight surgeries within the first 10 days,” Diane Holbert, Gibson-Holbert’s great-grandmother, said.
Gibson-Holbert’s Achilles tendon, which connects the calf muscle to the heel bone and helps a person walk, was severely damaged, creating another challenge for the surgeons. Tager collaborated with foot and ankle surgeons and used the tendon that flexes the big toe to reconstruct the Achilles.
To cover the large, open wound on Gibson-Holbert’s leg, Dr. Uygur and his team took a muscle from the back and transplanted it to the leg.
However, the surgical team had to change its plan mid-procedure after discovering the main artery they wanted to use in the leg was too badly damaged. Gibson-Holbert was repositioned, and a healthy vessel was located. To preserve the existing circulation in the leg, instead of cutting the vessel, the team made a small opening in the side of it and carefully connected the tissue.
Uygur then rotated a nearby calf muscle to cover some of the wound. Skin grafts were used to cover the rest.
“Pediatric microsurgery limb salvage is complex, and this case was unique in that two muscles were combined to cover the affected area to create a skin graft,” Uygur said.
He added that in children, blood vessels are very small, usually one-to-two millimeters in size. “It was a really challenging case.”
After spending two months in bed, Gibson-Holbert slowly began bearing weight on his leg. He works with a physical therapist both at Children’s and at WVU Medicine Uniontown Hospital.
Though he and his family realize he still faces a long road of recovery, he’s making progress – even playing basketball and riding his dirt bike.
Gibson-Holbert’s skin grafts have fully healed, but he wears a brace below his left knee while his reconstructed Achilles tendon heals. Still, he and his family couldn’t be happier with the care they received and the efforts the team at WVU Medicine made to save his leg.
“Our family will be forever indebted to Children’s Hospital,” Diane Holbert said. “The staff and doctors involved were and still are miracle workers. God gave us Dr. Tager in ortho and Dr. Uygur in plastic surgery. We are confident that with teamwork and God almighty, this young man will be able to recover. Thank you so much from the bottom of our hearts.”
To learn more about WVU Medicine, visit WVUMedicine.org.
