OneThousandOne represents the amount of time, verbally, that it takes to count to one second. In this one second of time, a great thing happened at Nebraska Medicine. In fact, several great things probably happened. A patient was cured, a researcher found the missing link, a nurse treated an injury, a doctor comforted a family or maybe a child just smiled.
Spring | Summer 2012

Restoring Vitality

There’s no place like home. For 90-year-old Paul Hodgson, MD, who nearly lost his independence, that old saying rings more true today than ever before.

“Everywhere I look, I have memories,” he says as he gazes about the house that he and his wife moved into in 1963 and raised a family. “And I have things to do. I have my books to read, my woodworking, my gardening.”

Paul Hodgson, MD
Paul Hodgson, MD

There are the memories of his wife, Barbara, fondly known as Oz, who passed away nearly two years ago. Special memories of his children, holidays and family gatherings. And as he sits in his sunroom and peers outside, he looks at some 20 trees that he and his family have planted over the years and proudly recites the species and home territory of each.

Second to his family, has been Dr. Hodgson’s dedication to his career. A retired surgeon at the University of Nebraska Medical Center (UNMC) where he practiced for more than 25 years, he served as chairman of the Department of Surgery from 1972 to 1984. In 2006, Dr. Hodgson was named one of The Nebraska Medical Center’s “Legends,” awarded to retired physicians who have demonstrated remarkable leadership, professionalism and friendship.

While Dr. Hodgson may have retired in name, he hasn’t retired in spirit. Since his retirement in 1988, he has continued to remain active at the medical center, attending department functions and lectures. Until a recent hospitalization, he faithfully attended Grand Rounds each week. Only a snowstorm or illness would keep him away.

In the fall of 2009, Dr. Hodgson began to notice that his legs would tire while walking from the parking lot to Grand Rounds. He started wearing support hose to prevent edema. Then he developed an ulceration on his right calf. When it wouldn’t heal, he asked one of his colleagues to look at it. That colleague ordered a series of diagnostic studies that showed the arteries in his right leg were obstructed. The small wound had grown into a larger one that refused to heal. It was the beginning of a long battle that would take two years and five operations and almost caused him to lose his leg. But Dr. Hodgson is well now and on the road to recovery thanks to the care provided by the multidisciplinary limb salvage team at The Nebraska Medical Center.

The limb salvage team employs the most advanced medical and surgical techniques to diagnose and treat serious wounds and complications that commonly occur among people with diabetes and peripheral artery disease (PAD). These are individuals who might otherwise face amputation. The team is composed of vascular surgeons, orthopedic surgeons and plastic and reconstructive surgeons.

Matthew Longo, MD
Matthew Longo, MD

PAD is associated with plaque buildup in the arteries that produces an obstruction to the head, organs and limbs. When it occurs in the arteries in the legs, it prevents oxygen from reaching the limbs leading to pain and numbness and raising the risk of infection. The absence of oxygen, combined with a lack of blood flow to carry infection-fighting white cells, results in very slow-healing wounds or wounds that refuse to heal at all. Even minor scrapes can result in open sores that heal slowly. If severe enough, PAD can produce gangrene (tissue death) and may lead to leg amputation. The same is true for diabetes, which often is associated with atherosclerosis. Approximately 60 percent of wound infection cases that result in amputation occur in diabetic patients.

“Our goal is to prevent amputation,” says Matthew Longo, MD, vascular surgeon at The Nebraska Medical Center and associate professor for the Department of General Surgery at UNMC. Dr. Longo specializes in advanced vascular surgery techniques to restore blood flow to blocked arteries. “Amputation is a life-altering situation that can take away people’s mobility, independence and lifestyle. When you amputate older people, they become wheelchair bound and they lose their independence. We work with people who believe their only option is an amputation, and we use advances in wound care surgery and technology to restore blood flow again and prevent amputation.”

“Minimally invasive approaches result in fewer complications, less patient pain and stress, minimal morbidity and provide excellent outcomes.”
Matthew Longo, MD

Not only does amputation rob a person of their mobility, but it is also associated with a 30 percent mortality rate within the first two years, says Dr. Longo.

The vascular surgeons at The Nebraska Medical Center offer all of the latest minimally invasive and open surgical techniques to provide patients with the fullest range of options that can be tailored to best suit their needs. “Minimally invasive approaches result in fewer complications, less patient pain and stress, minimal morbidity and provide excellent outcomes,” says Dr. Longo.

The team also uses state-of-the-art diagnostic tools to detect arterial disease, to determine oxygen levels in tissue and to evaluate the severity of the disease. Vascular surgery combined with advanced wound care therapy that includes highly developed biological dressings that expedite healing as well as complex wound skin grafting and reconstructive surgery have helped heal some of the most serious wounds.

Debra Reilly, MD
Debra Reilly, MD

Debra Reilly, MD, plastic and reconstructive surgeon at The Nebraska Medical Center, specializes in complex reconstructive surgery to help wounds heal through the use of grafts, flaps and microsurgery. “Everything has to be done in collaboration and timed well with the vascular surgeons,” says Dr. Reilly, who is also an associate professor for the Section of Plastic and Reconstructive Surgery at UNMC. “I can’t do my work until the blockages in the blood vessels have been opened so the affected areas have blood flow to heal.”

In Dr. Hodgson’s case, the small lesion on his right calf had grown from becoming a nuisance to a serious wound, the consequences of severe PAD. The first step involved Dr. Longo performing vascular bypass surgery to restore blood flow to the lower leg. Dr. Longo placed an artificial blood vessel in the groin and reconnected it to vessels in the calf. Once blood flow had been restored, the wound could begin receiving critical oxygen and infection-fighting cells to promote healing.

“Everything has to be done in collaboration and timed well with the vascular surgeons.”
Debra Reilly, MD

Dr. Hodgson spent the next several months at a rehabilitation facility while oxygen-rich blood was allowed to reach the wound and stimulate healing. During that time, he also developed a sore on his left foot that wouldn’t heal. It became apparent that he had lost blood flow to the toes. Dr. Longo performed another vascular bypass surgery to restore blood flow to the foot. The team was able to save the leg but his toes had become gangrous and had to be amputated.

With blood flow restored to the new blood vessels in his right leg, his lesion could heal and Dr. Hodgson returned to surgery once more. This time, Dr. Reilly cleaned and removed dead tissue in the area and then performed a series of surgeries over the next few months using artificial skin grafts to promote healing. The last operation involved a real skin graft to complete the healing process and an amputation of the left forefoot.

“What they have accomplished is all pretty amazing,” says Dr. Hodgson. “They are a first-rate team and what they have done for me is an outstanding effort.”

After approximately two years of operations and recovery, Dr. Hodgson was well enough to return to the comforts of his own home. He has consolidated his living space to the first floor of his home where he does quite well. He wears a prosthesis in his left shoe to provide him support when he walks and even gets around without the help of his cane. His son stops by several times a week to help prepare meals and during the spring and summer months, he helps Dr. Hodgson maintain the family garden, which he has cultivated for nearly 50 years.

“What they have accomplished is all pretty amazing. They are a first-rate team and what they have done for me is an outstanding effort.”
Paul Hodgson, MD

If there’s one thing for sure, Dr. Hodgson has not let this event slow him down. In fact, he has picked up right where he left off just before his illness. “I prepare meals, do light housekeeping, read the newspaper, my history books and the great 100 novels,” he says. “In the spring, I hope to be able to do some gardening. And I’m slowly but surely pursuing many of the activities I love like church, visiting friends, gardening, going to the Joslyn and symphony.”

In January, Dr. Hodgson began attending weekly Grand Rounds again to fuel his insatiable thirst for knowledge. “It’s a hard habit to break,” he says. He used to attend with several retired colleagues, but even they have stopped attending. “I’m the only one now,” he says. “I like to hear about all the new advances and how they are solving old problems. I like to meet the new faculty and see some of the older ones too, some of whom have been long-standing colleagues.”

Dr. Hodgson says he still has a lot he wants to do. “I’m about 10 years behind in my retirement so I’ve got a lot of catching up to do,” he says. “But really, I’m just pleased to be alive. And I have the outstanding effort of the surgery team to thank for that.”

Even more importantly, he has his independence, his home and all of the memories inside. And for Dr. Hodgson, they bring comfort, smiles, laughter and sometimes, even tears. But there’s nowhere else he’d rather be.

Next article in the Spring | Summer 2012 issue of One Thousand And One:
Life as Usual