Patient Experience: Limb-saving reconstruction surgery

Kelly Lewis was admitted to the John Radcliffe Hospital for amputation below the knee, following a severe bone infection that was further exacerbated and complicated by diabetes.

Kelly fractured her ankle in a fall, which she could not sense for about three weeks due to her neuropathic condition. She was admitted to a local hospital following a diagnosis of sepsis and, once stabilised, was transferred to the John Radcliffe Hospital for her amputation.

However, the team at OUH said that they wanted to try and save Kelly's leg - and that is exactly what they did. This came as a huge surprise and nothing short of a miracle when Kelly was informed that there was a possibility to save the limb.

Kelly was transferred to the Nuffield Orthopaedic Centre, where she was informed from the start about the complications of the procedure. These included a low possibility of success, possibly eventually requiring the amputation, and the long and difficult recovery if the operation was successful. However, the idea of saving the leg she had prepared to lose motivated her to take the alternative option.

A dedicated team of expert healthcare professionals at OUH including plastic surgeons, infectious diseases consultants, orthopaedic surgeons, specialist nurses, diabetes specialist nurses, physiotherapists, and staff from the Bone Infection Unit and admin team came together to accomplish an almost impossible procedure.

The operation was a success. After a 12-hour operation and further reconstructive surgery, Kelly is now on the road to recovery.

Invited to share her experience at an in-person Trust board meeting earlier this year, Kelly spoke about the journey of saving her limb and the exceptional compassionate care she received at OUH.

Kelly said: "I had a fall, but I could not feel anything but mild pain. I scheduled an appointment after cutting my leg while shaving and associated the growing pain with that. I learned that I had fractured my ankle three weeks after the fall.

"When I went to the local hospital, they ran some blood tests. I was called in the middle of the night because the blood test showed sepsis, which is life-threatening.

"When I was stabilised, I was told that the threat of sepsis still remained and due the severity of the infection that had reached my bones, I would need an imminent amputation.

"By the time I was admitted to the JR, I had accepted that I was going to lose my leg and that it would change my life. I cannot express in words how exhilarated I was when I heard that there was a chance, albeit very small, to save my leg.

"I know that the consultants and teams were trying to manage my expectations, but I had trust in them, simply because of the care, honesty and compassion I was shown so far at the hospital.

"I was transferred to the Nuffield Orthopaedic Centre for the surgery, where I met David Jones. David played a key role in helping me manage my diabetes and even now, I am in contact with him and can call him for advice at any point. It was refreshing that for the first time in my experience with diabetes, I was heard and treated respectfully. Often there is a tone of judgement, but David always treated me with compassion.

"The surgery went well. I was impressed and touched by the care and kindness everyone showed me.

"I have had a major setback which reversed and slowed my progress. Quite recently, I accidently put some weight on my leg and ended up breaking my tibia requiring another surgery. I was apologetic the whole time, but I was met with empathy and understanding.

"I am nothing but grateful to all the teams and individuals who contributed to the care I received. Experiences like this restores your faith in healthcare."

David Jones, a Diabetes Specialist Nurse at OUH said: "With Kelly, due to her invasive infection and urgent need of surgery, we had to work quickly to get her fit for the surgery. So, it was a priority for us to get her blood-sugar levels stable.

"Kelly has had diabetes for a long time and had lots of different advice to help with the management. It is vital with patients that the focus should be on listening to them before starting to make lifestyle adjustments, to ensure that the progress is achieved and sustained. It also involves removing the stigma around diabetes in order to inform, educate, and empower the patient and colleagues.

"Understanding how important it was for her, I was happy to support Kelly at any time if she ever had a question. There are setbacks in a journey like this, it’s crucial to pick up and keep working at it.

"This case is an example of the patients working with healthcare provider to achieve the best outcome. Kelly was really engaged in her journey."

Adrian Kendal, Consultant Orthopaedic Surgeon at OUH, said: "Kelly had severe life and limb threatening infection of her lower leg, with massive soft tissue loss that exposed her bone. She was on the edge of what we could technically cure and re-construct. In most places, her only option would have been a below knee amputation.

"The Bone Infection Unit provides world-leading care for patients like Kelly. We are extremely fortunate to be able to work as part of a multidisciplinary team.

"Working as a team means that these types of limb-saving, reconstructive operations can be performed successfully and have a huge impact on a patient's life journey. It was a long road for Kelly, and she has been incredible."

Alex Ramsden, Consultant Plastic and Reconstructive Surgeon at OUH said: "Working in collaboration with a wider team of specialists allowed the challenging reconstruction of the devastating wounds on Kelly's leg. Modern health care can deliver outstanding results that would not have been possible a few years ago.

"It is rewarding for our teams and trainees to help motivated patients overcome huge challenges and get them back on their feet again."

Professor Andrew Brent, Chief Medical Officer at OUH said: "I am immensely proud of the limb-saving procedure performed by our dedicated teams at OUH. This is just one example of the remarkable care that they provide to patients, day in day out, and is a testament to the team's exceptional skill, collaboration, and unwavering commitment to provide the best possible outcomes for our patients.

Rikki Lewis, Kelly's husband said: "The care Kelly received at OUH has been second to none. I am grateful to everyone involved for saving my wife's leg – they have performed nothing short of miracle."