March 8, 2019

UAMS Specialists Save Arm, Put Biker Back on the Road

UAMS' James Yuen, M.D., (left) and Syed "Ash" Hasan, M.D., recently visited with Michael Jevicky (center), whose arm they saved after a motorcycle accident.

UAMS’ James Yuen, M.D., (left) and Syed “Ash” Hasan, M.D., recently visited with Michael Jevicky (center), whose arm they saved after a motorcycle accident.

Ed and Margo Jevicky say a series of miracles saved their 18-year-old son, Michael, and his right arm when his motorcycle slammed into a Jeep. One of them was landing in the hands of two well-regarded, highly specialized University of Arkansas for Medical Sciences (UAMS) surgeons.

“It changed Michael’s. The outcome could have been so much different,” Ed Jevicky said.

The Jevickys, of Guy, recalled the experience during Michael’s follow-up visit with the two surgeons – Syed “Ash” Hasan and James Yuen, M.D. — who saved his arm.

Losing his arm was a real possibility because the trauma was extensive and unusual.

Hasan and Yuen, who have decades of experience between them, still marvel at what happened: A five-inch section of humerus bone from Michael’s upper right arm was ejected onto the pavement. It had come through a small hole near his elbow, and the bone was clean, free of any tissue.

Michael’s is such an unusual case that Hasan and Yuen said they’ve found no other like it in medical literature.

In addition, the main nerve in the arm – the ulnar nerve – had been severed. Hasan, an orthopedic shoulder and elbow specialist with expertise in microvascular surgery, repaired the nerve using a microscope to align the matching fiber bundles.

Next, Yuen, a plastic surgeon with expertise in microvascular surgery, joined Hasan for a procedure that’s akin to a living organ transplant. The eight-hour surgery required taking a section of Michael’s lower leg bone to replace the missing segment in his arm.

The procedure is properly called a microvascular free-flap transfer or microsurgical composite tissue transplantation. Yuen, a surgeon at UAMS since 1993, has performed more than 700 such procedures, but most have involved cancer patients.

Yuen quickly determined that the only place to harvest a living bone large enough and long enough to replace the missing humerus was the fibula in the lower leg, which can be removed without significantly affecting a person’s mobility. He harvested an eight-inch segment of the fibula, along with its still-attached artery and vein. By leaving the ligaments in place at the ankle and knee, Michael would have almost normal use of his leg.

The fibula replaced the missing segment of humerus, and the artery and vein were attached using microvascular techniques to provide circulation to the transferred bone.

Michael, now 19, has nearly all the physical ability that he had before the accident, even riding his motorcycle.

While still in a cast he was able to use his right hand to type, and he later went to Alaska, where he hiked extensively. He noticed weakness in his leg, but additional physical therapy improved that, and today he notices only slight tingling in his hand.

At the time of his accident, Michael was riding from his home in Guy to the Christian Motorcyclists Association club, called Gap Riders of Conway. He was within a few blocks of the meeting when the Jeep pulled in front of him. He recently returned to a club meeting on his motorcycle, driving by the scene of the accident. When he arrived, members of the group stood and applauded.