by Dawn Brazell
Public Relations

Ashley Whittle pats the back of her modish hairstyle and smiles shyly.

She's trying to adjust to her new looks having lost the waist-long hair she used to have. "I'm like a kitten who's all curious," she said, her manicured fingers playing in her hair. The miracle, other than that she has started to feel beautiful again, is that her hair's growing and with it a new sense of hope as she recovers from an industrial accident that happened Jan. 30 that tore off a section of her scalp and forehead.

Ashley Whittle at four months after a surgery where MUSC doctors reattached her scalp following an accident at a plant where she worked.

She has returned for a check-up to MUSC to visit with plastic and reconstructive surgeon Kevin Delaney, M.D., one that brings tears to the eyes of Whittle, 24, and her mother, Tammy, as they offer their thanks to Delaney and the team of doctors and nurses who have helped Whittle recover. A whiz in handling complicated microsurgery cases, especially replantations of amputated parts, Delaney was the one who got a call that Monday in January when doctors at a Columbia hospital were on the phone trying to find a hospital who could handle her case.

Delaney was glad to take her.

"I like solving problems. When people come in with complex injuries that require the highest level of reconstruction that typically involves microsurgery, that's very interesting to me and exciting. I like to see good outcomes in the patients I treat."

Delaney quickly assembled two surgery teams and had Whittle airlifted, for the second time that day, for treatment at MUSC. Meanwhile, Tammy had to travel by car, praying all the way that her daughter would survive, trying to block out the memories of the last few hours. When Tammy got the call that her daughter had been injured at the plant where she worked and was being flown to a hospital in Columbia, she panicked. "Time stopped for me then. I knew it couldn't be good."

She braced herself for what she would see, but still wasn't prepared when she arrived at the hospital in Columbia for the extent of the injuries. "She was losing blood consistently. It was a complete detachment. It was a very rare, rare case. It's not what any mother wants to see happen to her child. "

Ashley Whittle's mother, Tammy, gives her daughter a big hug at a recent visit to MUSC. To see a video, visit http://bit.ly/MicroSurgery.

The Surgery
A successful scalp replantation happens only a few times yearly nationwide, said Delaney. He was glad to get the call, given that he and his group do many extensive, complex surgeries involving microsurgery each year.

"It's difficult to treat because we have to take the tiny microscopic blood vessels that are still attached to the amputated scalp and, using a high-powered microscope, we have to attach those tiny arteries and veins to the surrounding arteries and veins still on her head to get adequate blood flow."

The vessels are one to three millimeters in size so it is delicate, painstaking work. Ashley's scalp amputation included a portion of her right eyebrow, which meant the piece of tissue that had to be sewn on was larger than usual and the vessels in the brow area were smaller, which made it even trickier.

Whittle just after her Jan. 30 surgery. Time was critical to the success of getting her scalp reattached by the two teams of microsurgeons required for the procedure.

"It was one of the most complex cases that we've had."

Ashley's surgery took two plastic surgery teams, and lasted about 10 hours. One group prepped the patient and the other cleaned the scalp that fortunately had been preserved by the first responders. Both groups identified the vessels to be used in surgery.

"I was on both teams. I was orchestrating the entire process until we did the microsurgery to hook the scalp up, and then I was involved with that whole process."

Doctors properly positioned the scalp back onto her head, temporarily securing it in place with sutures. Arteries and veins on the amputated scalp and that were identified and marked were unclamped and irrigated with an anti-clotting solution. Using the microscope, two microsurgeons worked together to hook up the ends of two to three veins between the amputated scalp and the patient. Once the veins were hooked up, the plastic and reconstructive microsurgeons began work on the arteries. Once completed, the blood vessel micro-clamps were removed and the blood flow was restored to the amputated scalp.

Delaney said the scalp immediately regained its color.

The blood vessel that were joined were then evaluated using a doppler machine that helps monitor the continued blood flow where the vessels had been joined. Monitoring at this stage is critical. Ashley went to the surgical intensive care unit where her scalp was monitored on an hourly basis by evaluating its color, temperature and turgor, as well as regular doppler probes to check the blood flow across the reconnected vessels.

Delaney said sometimes doctors have to use medicinal leeches to better control the blood draining properly, and this was the case for Ashley. Her mother, Tammy, said this part of the treatment gave her pause. "I said, 'Wait a minute.' I grew up in the country and I know what those leeches can do. You're going to have to explain this to me."

Ashley Whittle enjoys a visit with Drs. Kevin Delaney, left, and Jason Ulm, a plastic and reconstructive surgical fellow.

Ashley, who has intermittent memories of the whole time, was awake for this part of treatment and said it took some adjustment on her part. They explained how the leeches 'drink' the excess blood and produce hirudin, a natural anti-coagulant in their saliva that improves blood flow in the scalp. Ashley said it was tough, but she understood how it would help.

Her mother said she was so proud of her, both how she fought to survive her injury and how she pushed through recovery. "I was just completely amazed at what they had to do. I can't fathom the idea of having the nature of that kind of an injury happening to you. Thank God, she has some strength to deal with things. She kicked into survival mode."

Taking Root
Delaney said he's thrilled by Ashley's progress.

"When you have a patient who has a good attitude and who is willing to do what you ask during the recovery, then that helps to bring a good outcome."

He also praises the teamwork of doctors and nurses involved with her case. Advances in instrumentation has opened up all kinds of possibilities in microsurgery, giving plastic and reconstructive surgeons the ability to do incredible things for patients who have severe injuries. They have handled reattachments of all types of body parts, including fingers, hands and tongues. They also are able to do intricate, reconstruction surgery for cancer patients.

In Ashley's case, if doctors had tried to just cover her wound, she would have been left with a very, severe defect of her scalp. "She would have never had her own hair. She would have required multiple, additional operations just to close the wound and get the bone of her scalp covered and closed. She would have never been able to grow her own hair in that area."

Tammy, who's from Great Falls, said she's amazed every time she thinks about it. They treasure the relationships they formed, which is one reason they love coming back to Charleston for check ups to visit the staff again. "The nurses were amazed at her progress of recovery, " said Tammy. "She handled everything really well. It helped that they were young people, and they really related to her very well, down to cutting up with her about her fingernail polish. It turned a really bad experience into the best it could have ever been. None of this could have happened without the team of doctors she had."

Ashley said she doesn't remember much about the accident except that she was able to pull herself away from the napkin-folding machine that trapped her hair. "The next thing I knew I was in the back of an ambulance." She does remember being terrified of the flight from Columbia to Charleston because she's scared of heights, and waking up after surgery.

She spent 14 days at MUSC, and her recovery has gone smoothly. She finally has started sleeping better. The accident marks a turning point in her life. She has decided she wants get her GED and take a new path in life, she said. "It's amazing how quick my hair is growing and that I actually have a head-full of hair now. I had a great team and if it weren't for them, I wouldn't be here now and I wouldn't look as beautiful as I do right now."

Tammy beams at her daughter's statement. Part of the new confidence her daughter shows now comes from the support she's gotten from Delaney, who took control of her daughter's case and watched over every aspect. "I love the look of total amazement when he sees her. He didn't expect her hair to be anything like it is. He boosts her confidence in herself and lets her see how life goes on. She's able to look at herself and say, 'I am beautiful.'"