When Pagosa Springs businessman Steve Wirth lost everything except the bone and tendons of a finger in a home accident, a plastic surgeon restored the digits functionality, an aspect overlooked in a medical speciality more often associated with cosmetic surgery.
The take-home lesson is that plastic surgery restores areas of disformity on all areas of the body, said Dr. Ronald Ritz, the plastic surgeon who operated on Wirth. The reconstructive aspect of plastic surgery is quite broad and extensive.
Plastic surgeons employ their skills in healing victims of trauma, restoring the ravages of cancer and repairing congenital defects, Ritz said. They collaborate with general surgeons, orthopedists, radiologists, oncologists, neurosurgeons, ear-nose-throat specialists and pathologists.
Reconstructive work is an integral part of plastic surgery, said Ritz, who does 500 to 550 reconstructive and cosmetic surgeries a year.
Wirth, 66, who has owned a carpet store for 35 years, in late April was standing on a bench in his garage trying to reach a tool on a high shelf when he slipped, catching his wedding band on a bolt.
The fall did what surgeons call degloving. It stripped all flesh from the ring finger on his left hand and tore off the tip joint.
Wirths wife, Bobbi, asked their son Jared, who lived nearby, to find his dads finger tip while she took Wirth to Pagosa Mountain Hospital.
Bobbi Wirth said the stump looked like a half-eaten turkey drumstick bare bone and tendons hanging down. The ring, bent into the shape of a paper clip, remained on the bolt.
Wirth and the finger, packed in ice, went by ambulance to Durango to see Ritz, who gave him a choice amputate the finger at the hand or have it reconstructed.
When Wirth took the second option, Ritz created a Napoleon flap, a tube of skin on Wirths right chest, into which the stump of the injured finger was inserted. The finger remained in the cocoon three weeks, nourished by the flow of blood until it was repaired.
Now, eight months out, Wirth has regained the dexterity that he lost in the four digits from having the hand immobilized for three weeks. It will be two years before he gets maximum use of the ring finger, but he has sufficient grip to operate the clutch on his motorcycle.
In cold weather, Wirth wears a wool tube on the finger to prevent frostbite, which would require immediate amputation. But hes nothing short of amazed at his progress.
I dont have all the parts I was born with, but Im better than I might have ended up, he said.
A detail of offbeat humor: Wirths chest skin that was transferred to the finger still produces whiskers, so he periodically shaves the stubble.
Reconstructive cases such as Wirths comprise a sizeable portion of the practices of three plastic surgeons in Durango. Ritz does 60 percent reconstructive work; Dr. Ryan Naffziger, at least 40 percent; and Dr. Denis Winder, 50 percent.
Naffziger recalled an oil field worker whose left hand was crushed recently when a heavy pipe fell on it.
On a screen, he displayed images that showed in detail the condition of the injured hand and the extremity when it was repaired.
All the metacarpal bones were broken, Naffziger said. I opened the hand and put in plates and screws, which will remain permanently.
Hell require a lot of therapy, Naffziger said. Itll be three months before the hand gets as good as its going to get.
A patient he remembers, Winder said, was a 50-year-old man who had cancer in his jawbone.
It was involved, Winder said. We removed one side of his jaw up to the hinge joint and replaced it with a graft cut from his pelvis. He needed a special denture, but he looked normal after surgery, and he could eat.
Randall Atkinson, 51, a self-employed diesel mechanic who lives between Alamosa and Monte Vista, underwent surgery with Ritz in October 2010 after he slipped from a ladder and landed face first on the sharpened end of a pipe.
The impact tore off the left half of his nose and sliced off a chunk of his cheek between his eye and mouth.
Ritz made an incision behind Atkinsons left ear to store the nose cartilage until it was needed. He then cut a flap of skin from Atkinsons forehead between the hairline and eyebrows to build a new nose.
This is crazy stuff, Atkinson, who returned to work in 40 days, said during an interview. The doctor did a bang-up job.
Reconstructive surgery patients may speak glowingly of their experience, but in the publics mind, the specialty tends to get second billing behind cosmetic or elective surgery, the surgeons said.
Plastic surgeons remove tumors, repair burn scars, graft skin, transfer skin, muscle and bone and suture arteries and veins. There is some overlapping, such as in breast surgery, which can be done for aesthetic or health purposes.
Reconstructive surgery restores functionality and provides a psychological boost to the patient and the family as well, Naffziger said. It gives a feeling of wholeness.
Winder said: We try to give the person normality.