COLORADO SPRINGS, Colo.—Things were looking bad for Stephen Ogonowski. Antibiotic-resistant bacteria had devoured his right ankle down to the bone, leaving an inches-wide hole full of raw and ravaged tissue.
Amputation seemed certain, just as it was six months earlier when his left foot became infected and his leg had to be removed below the knee.
This time, though, podiatrist Dr. Bryan Groth assembled a diverse team of doctors and a new orthopedic device to surgically save the decimated foot—and most likely, Ogonowski’s life.
Now, the 56-year-old Colorado Springs man who spent much of 2008 living at Memorial Hospital hopes that by next year he will be walking again and even returning to work.
On a Friday in early November, 20 people—at least three of them surgeons—pack an operating room at Memorial Hospital. A cacophony of idle chatter plays to the steady chirp of the heart monitor. The bandages come off of Ogonowski’s foot, revealing a tomato-red patch of raw tissue across his ankle.
Two months earlier, Groth surgically removed chunks of tissue infected with Methicillin-Resistant Staphylococcus Aureus, or MRSA. The wound had grown rapidly because of Ogonowski’s poor circulation, and another doctor, Karl Dittrich, a vascular surgeon, had inserted a stent into the leg to remove a severe blockage.
For weeks afterward, Dr. Rupesh Jain, a plastic surgeon, worked to clean the gaping wound. Doctors succeeded in containing the dangerous infection, but not before it did irreversible damage to the foot.
Now, if all goes as planned, Dittrich will check the stent in Ogonowski’s leg that’s feeding the swollen, discolored foot with more blood. Groth will cut out the now-useless tendons and ligaments and fuse the foot to a shin bone, working on the notion that although it won’t function as it had before, even a largely immobilized real foot will give Ogonowski a better chance of walking than a prosthetic.
When Groth’s work is finished, Jain will graft skin over the wound.
With any luck, Ogonowski might soon be standing on his right foot again.
In March, Ogonowski went to Memorial Hospital’s Emergency Department “feeling poor,” he said. As a recovering alcoholic, he’d once beaten up his body. But those days were behind him. He was working temp jobs, had his own apartment, and had earned his certification as a drug and alcohol counselor.
But his fatigue was just one symptom from an array of medical complications at work. He was admitted for what turned into months.
“I was going to be discharged seven times,” he said.
Every time he thought he’d seen the worst, something else would happen—including a heart attack. His arteries were clogged, and on top of that, he was diagnosed with an antibiotic-resistant intestinal bug.
In May, a combination of MRSA and poor blood flow made his left foot gangrenous, and doctors were forced to remove it.
Several months later, that familiar sore returned on his remaining leg.
The easy thing would have been to remove the foot. But Groth knew what that could mean: “The mortality rates are so daunting,” he said; they soar for double-amputees in poor health. So he believed “limb salvage” was justified. He performs only about half a dozen such surgeries a year, usually on patients with fewer complications.
In surgery, Dittrich and the rest of the OR team don lead aprons, since he relies on X-ray images to chart the path for the stent.
Then, Groth takes over—with a saw. Like a mechanic, he goes to work on the intricate framework around the foot and ankle, removing damaged parts and fastening together those that remain. Once the ankle is in place, he drills metal rods through the bones. When he’s finished, a new device called a halo will be fastened to the leg with pins that go through it. The halo, officially called an Ilizarov apparatus, keeps the foot immobile, yet doesn’t encase it like a cast—a critical point for such a serious wound.
As Groth continues to work, Jain takes a device, similar to a cheese slicer, to remove skin from Ogonowski’s right thigh to use for the graft. He compresses the layer of skin, a twelfth of an inch thick, under a machine that punches holes into it, giving it a net-like appearance. It will be wrapped like gauze over the wound.
The procedure cost at least $20,000, but consider: No one specialist would have been capable of performing the job alone. And the doctors were aided by new techniques and devices, such as the halo, that weren’t available several years ago.
A little over a week later, on Nov. 18, Ogonowski stands on the foot in Groth’s office for one of the first times after his surgery. It seeps blood, and the wound is still angry. Overall, though, Groth is pleased.
After the doctor leaves, Ogonowski talks eagerly about getting out of the nursing home where he’s been staying.
“I’m kind of looking forward to next spring or next summer. Life’s going to begin again.”
