Kelsey Ward nearly died 10 months ago in a terrible accident as she was driving home. But what happened since then has Kelsey now helping to make medical history. That's because doctors at San Antonio Military Medical Center tried something that's never been done before in Texas.
In fact, it's been done fewer than ten times across the country. That's 're-planting' an arm that was severed above the elbow. Replantation is the technical name for surgical reattachment.
The results in Kelsey's case continue to amaze her doctors and rehab specialists at the Center for the Intrepid. Her occupational therapist Christopher Ebner says it was the quick thinking of the First Responders who made the replantation even possible.
"Everything those guys did - the San Antonio Fire Department - was spot on. I don't think they could have done anything differently and her rescue and recovery was a direct result of the steps they took. That was the foundation of Kelsey's success that we're seeing right now."
Kelsey doesn't remember much about the wreck. She had left work at a restaurant early one morning but doesn't even remember getting in the car. So she's not sure what happened that caused her SUV to roll off an exit ramp and turn over.
That's when a metal guardrail punched through her passenger window and lopped off her right arm just below her shoulder. She was trapped inside and hanging upside down. But after that, whatever could go right ... did.
San Antonio firefighters and paramedics arrived quickly and got right to work using tourniquets to keep her from bleeding to death while they raced to free her from the SUV. "Then when we got her out of the car, that's when someone said 'y'all need to look for the arm'," San Antonio Firefighter Ryan Dunivan remembers.
"We were walking around and I happened to see just her fingertips on the other side of the vehicle under the roof of the car. Then we got spreaders under there just enough to pull the arm out."
—Ryan Dunivan, San Antonio Firefighter
So they were able to get her severed arm on the ambulance with the rest of Kelsey just before it pulled away and headed for Fort Sam Houston and the Level One Trauma Center at SAMMC.
"I was thinking there's absolutely no way. Most of the time these (accident victims) are crush injuries and not amenable to replantation."
—Dr. (Lt. Col.) Joe Alderete
Dr. (Lt. Col.) Joe Alderete was the only trauma surgeon on call that night. He was reluctant, knowing the odds are incredibly slim for anyone to simply be a good candidate for arm replantation, let alone avoiding the infections and other complications during the many surgeries that would be needed.
But then he saw the pictures of exactly what the guardrail had done. And the 'good news' was that the metal had sliced fairly cleanly through Kelsey's arm, much like a knife. That would make the severed tissue easier to reattach, though her severed arm had several broken bones and she had also suffered other injuries in the crash, including a broken pelvis.
Alderete's massive team would include two vascular surgeons, a hand surgeon, another back-up hand surgeon and a plastic surgeon, along with many other SAMMC medical staffers.
"We were at one point - for the first ten hours of surgery - working on her at once. So just being able to bring the team together was incredible."
—Dr. (Lt. Col.) Joe Alderete
To replant and rebuild Kelsey's arm, over the last nine months they've performed a series of surgeries, taking skin from one of her legs and deeper tissue from the other leg, which they used to help splice together major nerves.
And while they were able to hook up Kelsey's ulnar nerve directly, they needed grafts for the median and radial nerves, and until the last few years, that wasn't a realistic option. "But where we have moved forward so much in the last 15 years at war with so much catastrophic nerve injury, we've learned that biology is not only possible, but it's now a mainstay." And now nearly ten months after her arm was cut off, Kelsey is also a living case study in what's possible in rehabilitation, as she's working with experts at the Center for the Intrepid at Fort Sam Houston.
Kelsey is now able to bend her elbow, with some movement of her hand and fingers. She can give you a unique, backhanded high-five, but the most impressive thing she can do is pushups.
Yes, real pushups. And she dropped down and did several on Tuesday at San Antonio Fire Station #48 as she visited some of the First Responders who saved her life and her limb.
"We weren't expecting the arm to ever be reattached, honestly," Firefighter Robin Scibner admits. "We didn't even know what her prognosis was at that point."
But they were curious about what happened to her. And then shocked to find out how well she was doing when they first visited her last fall.
Kelsey again thanked them for saving her life and admitted that she, too, is surprised at the speed of her recovery.
"I actually have a lot of use with my arm. More than I thought I was going to get at the nine-month mark. We actually didn't think we were going to see any movement for a year at all. Not even elbow movement."
But doctors point out that Kelsey also happens to have a great attitude, which they say is another key to successful outcomes. "You've got to be tough," Kelsey says of the ongoing pain of rehab work.
"I think there's a reason God picked me. I'm strong. I want everybody to know that I'm not going to give up and hopefully this is a medical breakthrough and it saves lives and helps people."
"It's worse than going through labor. It's the hardest thing I've ever had to do. But I want my kids to know that there's nothing in this world that they're not capable of doing - and I'm living proof."
If you happen to catch a glimpse of Kelsey's other arm, you might notice the tattoo - which she had put on a few months after the accident. "It just says 'My story isn't over yet.' I wanted that because it was the most meaningful to me."