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Lockwood man's arm rebuilt after hunting accident
By JAMES HAGENGRUBER of the Billings Gazette
12/13/02
A hunting accident left most of Kurt Guthrie's upper arm scattered far and wide over a field near Melstone.
Thank God for spare parts.
A Billings surgeon borrowed bits and pieces from Guthrie's lower leg, thigh and chest to rebuild what a .338-caliber bullet blew away. After a year of rigorous therapy - during which his chest muscle had to be retrained as a bicep - the left arm is almost as good as new.
"It's close to a miracle," said Terry Calkins, a certified hand therapist at St. Vincent Healthcare who helped Guthrie regain use of the arm.
Guthrie, a Billings machinist, was wounded Oct. 27, 2001, while hunting with a friend. The two were dragging an antelope back to their truck. Guthrie was carrying both rifles when his friend's weapon slipped off his shoulder. He heard an explosion when the butt of the rifle hit the ground. The bullet went into the base of his bicep, just above the elbow.
The pain was unbelievable. And most of his upper arm, including the bone, was completely gone. A hunting vest was wrapped around the remaining tricep muscle - the thin muscle group at the back of the upper arm - to slow the bleeding. Guthrie and his friend drove to a ranch house to phone for help.
Guthrie smoked a cigarette on the way, thinking he lost his arm. But a bigger worry, he said, was bleeding to death.
St. Vincent's HELP Flight helicopter team met the ambulance halfway between Melstone and Roundup. The crew aboard the helicopter, thankfully, had morphine to numb the pain.
"I thought I lost my arm," Guthrie said. "I was just praying I'd stay alive."
The helicopter touched down just before sunset. An operating room had been readied and Guthrie was rushed into surgery. His wound was cleaned and the bleeding stopped.
Guthrie had lost nearly all of his upper-arm bone, his entire bicep muscle and a large patch of skin. The surgery would have been a simple amputation 20 years ago, but doctors have since discovered hidden repair kits built into the human body.
"We have expendable parts. It's taken medicine a while to figure that out," said Dr. Curt Settergren, the upper-extremity specialist who worked on Guthrie.
Before joining the Orthopedic Surgeons practice in Billings in 1991, Settergren trained at the Mayo Clinic, in Rochester, Minn. His mentor was a pioneer in the new technique of using bone from the lower leg to repair damaged bone in other parts of the body.
During a 12-hour surgery four days after the accident Settergren harvested a 6-inch piece of Guthrie's fibula - the smaller of the two lower leg bones. The bone was screwed to the remaining upper arm bone fragments near Guthrie's elbow and shoulder.
With a new bone in place, Settergren then made a long incision down Guthrie's back to access replacement muscle tissue. The latissimus dorsi muscle - used to pull the arm down and in - was cut off at the base of the back and draped over the top of Guthrie's shoulder. The bottom of the muscle was attached at Guthrie's elbow. This was to be his new bicep.
The new bicep muscle, however, had trouble with blood exchange. Despite all the massages and medications, Guthrie's new upper arm continued to swell. Settergren opened up the arm again to fix the trouble, but the work was in vain.
Settergren wasn't about to give up. He made another attempt; this time he would try using Guthrie's pectoralis muscle, which stretches across the front of the chest, from the shoulder down to the abdomen.
Guthrie's pectoralis was cut off at his abdomen and diverted over his shoulder to create a new bicep. Skin from the back of his arm was pulled around to the front. Skin was also peeled from Guthrie's thigh and grafted onto the rebuilt upper arm.
This time, the post-surgical swelling eventually went down. The surgery was a success.
Settergren was thrilled at putting his patient back together again, but doubted Guthrie would ever have full use of the arm.
"I didn't think he'd ever be a machinist again. At best this would be a helper hand," Settergren said.
Enter Terry Calkins, a certified hand therapist for St. Vincent. The therapy sessions began with Guthrie's arm setting limp on a table. He didn't even have the strength to fight gravity.
Guthrie could make a fist, though - a sign that his radial nerve was not irreparably damaged. The radial nerve is a vital conduit for signals from the brain to the hand. But the damage was enough that he could not open his clenched fingers. Calkins built a harness using rubber bands to allow Guthrie to extend his fingers.
A bigger trouble, though, was the "muscle re-education," Calkins said.
The brain is a bit confused when body parts get shifted around. Muscles are hard-wired to do certain tasks and Guthrie's new bicep still thought it was pectoralis.
In order to lift his forearm, Guthrie had to focus on flexing his chest. The action would trick the diverted muscle to fire.
"After a while, the brain learns," Calkins said.
About six weeks after he was wounded, Guthrie began to regain some strength and control. He returned to work at Northwest Industries in Lockwood. But he didn't have enough strength to resume his work on a milling machine.
The therapy was intensive and often painful, but Guthrie kept at it. He would drive to the hospital for his regular sessions, using the same hand to steer and shift. His rebuilt left arm could hold the steering wheel straight, but didn't have enough power to turn a corner.
Throughout winter and spring Guthrie made progress. On May 24 Calkins and Settergren agreed he could resume a vital slice of normalcy: golf. Guthrie went to the course the same day. Calkins joined him.
The expenses for the trauma care, five surgeries and year of rehabilitation totaled about $200,000, Guthrie said. But Guthrie has no insurance. He paid some of the bill by cashing out his retirement account. For the next year, much of his paycheck will go to paying the rest.
This doesn't bother Guthrie one bit.
"I have my arm back," he said, grinning.
Guthrie is now able to curl 13 pounds with his rebuilt arm. His healthy arm can handle 50 pounds, but Guthrie is more than happy with the progress he's already made. His arm is essentially back to normal, he said.
The whole experience has left him in awe of the human body, as well as the people who put him back together again.
"I'm surprised they have this good of doctors in Billings," Guthrie said.
He also learned one other lesson: "No more carrying my friend's gun, that's for sure."
By JAMES HAGENGRUBER of the Billings Gazette
12/13/02
A hunting accident left most of Kurt Guthrie's upper arm scattered far and wide over a field near Melstone.
Thank God for spare parts.
A Billings surgeon borrowed bits and pieces from Guthrie's lower leg, thigh and chest to rebuild what a .338-caliber bullet blew away. After a year of rigorous therapy - during which his chest muscle had to be retrained as a bicep - the left arm is almost as good as new.
"It's close to a miracle," said Terry Calkins, a certified hand therapist at St. Vincent Healthcare who helped Guthrie regain use of the arm.
Guthrie, a Billings machinist, was wounded Oct. 27, 2001, while hunting with a friend. The two were dragging an antelope back to their truck. Guthrie was carrying both rifles when his friend's weapon slipped off his shoulder. He heard an explosion when the butt of the rifle hit the ground. The bullet went into the base of his bicep, just above the elbow.
The pain was unbelievable. And most of his upper arm, including the bone, was completely gone. A hunting vest was wrapped around the remaining tricep muscle - the thin muscle group at the back of the upper arm - to slow the bleeding. Guthrie and his friend drove to a ranch house to phone for help.
Guthrie smoked a cigarette on the way, thinking he lost his arm. But a bigger worry, he said, was bleeding to death.
St. Vincent's HELP Flight helicopter team met the ambulance halfway between Melstone and Roundup. The crew aboard the helicopter, thankfully, had morphine to numb the pain.
"I thought I lost my arm," Guthrie said. "I was just praying I'd stay alive."
The helicopter touched down just before sunset. An operating room had been readied and Guthrie was rushed into surgery. His wound was cleaned and the bleeding stopped.
Guthrie had lost nearly all of his upper-arm bone, his entire bicep muscle and a large patch of skin. The surgery would have been a simple amputation 20 years ago, but doctors have since discovered hidden repair kits built into the human body.
"We have expendable parts. It's taken medicine a while to figure that out," said Dr. Curt Settergren, the upper-extremity specialist who worked on Guthrie.
Before joining the Orthopedic Surgeons practice in Billings in 1991, Settergren trained at the Mayo Clinic, in Rochester, Minn. His mentor was a pioneer in the new technique of using bone from the lower leg to repair damaged bone in other parts of the body.
During a 12-hour surgery four days after the accident Settergren harvested a 6-inch piece of Guthrie's fibula - the smaller of the two lower leg bones. The bone was screwed to the remaining upper arm bone fragments near Guthrie's elbow and shoulder.
With a new bone in place, Settergren then made a long incision down Guthrie's back to access replacement muscle tissue. The latissimus dorsi muscle - used to pull the arm down and in - was cut off at the base of the back and draped over the top of Guthrie's shoulder. The bottom of the muscle was attached at Guthrie's elbow. This was to be his new bicep.
The new bicep muscle, however, had trouble with blood exchange. Despite all the massages and medications, Guthrie's new upper arm continued to swell. Settergren opened up the arm again to fix the trouble, but the work was in vain.
Settergren wasn't about to give up. He made another attempt; this time he would try using Guthrie's pectoralis muscle, which stretches across the front of the chest, from the shoulder down to the abdomen.
Guthrie's pectoralis was cut off at his abdomen and diverted over his shoulder to create a new bicep. Skin from the back of his arm was pulled around to the front. Skin was also peeled from Guthrie's thigh and grafted onto the rebuilt upper arm.
This time, the post-surgical swelling eventually went down. The surgery was a success.
Settergren was thrilled at putting his patient back together again, but doubted Guthrie would ever have full use of the arm.
"I didn't think he'd ever be a machinist again. At best this would be a helper hand," Settergren said.
Enter Terry Calkins, a certified hand therapist for St. Vincent. The therapy sessions began with Guthrie's arm setting limp on a table. He didn't even have the strength to fight gravity.
Guthrie could make a fist, though - a sign that his radial nerve was not irreparably damaged. The radial nerve is a vital conduit for signals from the brain to the hand. But the damage was enough that he could not open his clenched fingers. Calkins built a harness using rubber bands to allow Guthrie to extend his fingers.
A bigger trouble, though, was the "muscle re-education," Calkins said.
The brain is a bit confused when body parts get shifted around. Muscles are hard-wired to do certain tasks and Guthrie's new bicep still thought it was pectoralis.
In order to lift his forearm, Guthrie had to focus on flexing his chest. The action would trick the diverted muscle to fire.
"After a while, the brain learns," Calkins said.
About six weeks after he was wounded, Guthrie began to regain some strength and control. He returned to work at Northwest Industries in Lockwood. But he didn't have enough strength to resume his work on a milling machine.
The therapy was intensive and often painful, but Guthrie kept at it. He would drive to the hospital for his regular sessions, using the same hand to steer and shift. His rebuilt left arm could hold the steering wheel straight, but didn't have enough power to turn a corner.
Throughout winter and spring Guthrie made progress. On May 24 Calkins and Settergren agreed he could resume a vital slice of normalcy: golf. Guthrie went to the course the same day. Calkins joined him.
The expenses for the trauma care, five surgeries and year of rehabilitation totaled about $200,000, Guthrie said. But Guthrie has no insurance. He paid some of the bill by cashing out his retirement account. For the next year, much of his paycheck will go to paying the rest.
This doesn't bother Guthrie one bit.
"I have my arm back," he said, grinning.
Guthrie is now able to curl 13 pounds with his rebuilt arm. His healthy arm can handle 50 pounds, but Guthrie is more than happy with the progress he's already made. His arm is essentially back to normal, he said.
The whole experience has left him in awe of the human body, as well as the people who put him back together again.
"I'm surprised they have this good of doctors in Billings," Guthrie said.
He also learned one other lesson: "No more carrying my friend's gun, that's for sure."
