Microvascular Surgery Key to Recovery of San Francisco Giants' Top Prospect Gustavo Cabrera

The San Jose Mercury News reports on the remarkable recovery of Gustavo Cabrera from a potentially catastrophic injury to his right hand in 2013 sustained while at home in the Dominican Republic.

Cabrera's injury threatened not only his baseball career, but the loss of function, if not the loss of the hand itself. A team comprised of Scott L. Hansen, M.D. (pictured right), Chief of Hand and Microvascular Surgery at UCSF,  Charles Lee, M.D., Director of Microsurgery at St. Mary's Medical Center, and San Francisco Giants' chief surgeon Dr. Robert Murray, repaired the damage to Cabrera's hand and, despite seemingly long odds, Cabrera has been able to resume his baseball career. The gripping account descibing his injury, subsequent treatment and incredible recovery, as told by Mercury News reporter Andrew Baggarly, is highlighted in excerpts below. A link to the full story appears at the end.

Pablo Peguero answered his cellphone, and the voice on the other end was frantic. In between sobs from Gustavo Cabrera's mother, Alexandra Alvarez, he understood that something terrible had happened. She told him that Cabrera, just 17 at the time, had a fall in his home. He was balancing a plate of food when he dropped a cup of water. He tried to pick up the cup while bracing his right hand on a glass table and slipped on the wet floor. His right arm went through the glass. Blood was everywhere. Just above his throwing hand, he severed every sinew, nerve and major blood vessel down to the bone.

Cabrera was flown from Santo Domingo to Phoenix, Arizona near the Giants training camp in Scottsdale. It was there that the team realized the dire situation Cabrera was in. The Giants put him on a plane to San Francisco so he could receive treatment at UCSF Medical Center. 

Rodriguez and Cabrera had a connecting flight in New York and then landed in Phoenix, where the Giants instantly recognized that the injury was far more devastating than they could handle there. Cabrera had cut through every single one of the 11 tendons on the volar (palm up) side of his arm. Almost 40 hours had passed since the accident, and the only blood supply his hand had received was whatever scant amount his capillaries could squeeze through.

They raced Cabrera back to the airport, and to San Francisco. Time was running out, and one more bureaucratic stumbling block would threaten everything.

THE SURGEON

Dr. Scott Hansen, the chief of hand and microvascular surgery at UCSF Medical Center, reviewed cellphone pictures of Cabrera's arm while the teenager was en route to the Bay Area from Phoenix. He knew every minute was critical, and he wanted to be as prepared as possible for what he needed to repair.

Hansen had seen and stitched up hundreds of injuries more traumatic and destructive. He has created thumbs out of toes. But most of those patients were people who suffered industrial accidents or were mangled in high-speed car wrecks. Never a professional athlete.

"He had what we call a 'spaghetti wrist,' " Hansen said. "All the key structures are on the volar side, and he cut everything straight across. It was just a terrible, terrible, terrible injury."

Hansen and Dr. Charles Lee, chief of plastic and reconstructive surgery at St. Mary's Medical Center in San Francisco, often collaborate in complicated microsurgery procedures. (They repaired nerve damage in Jeremy Affeldt's hand when the former Giants left-hander suffered a deep stab wound while trying to separate frozen hamburger patties in 2011.) Now they, along with Giants chief surgeon Dr. Robert Murray, prepared to operate on Cabrera.

But with the clock ticking, officials at St. Mary's Medical Center initially refused to allow the procedure. They required a legal guardian to sign for Cabrera, and the Giants couldn't produce one. Like Peguero in the Dominican, the Giants had a connected person to cut through the bureaucracy. Murray, a practicing physician for 41 years and a St. Mary's Board member, knew the right people to call and the right forms to process.

The operation took almost five hours, with Hansen and Lee simultaneously repairing structures using a multiheaded surgical microscope. Repairing those 11 tendons was the most straightforward part. Reconnecting tiny blood vessels, using sutures that can't be seen with the human eye, was delicate but nothing they hadn't done hundreds of times.

It was reconnecting the nerves that most concerned Hansen and Lee. A cut nerve dies off in both directions. After 48 hours, there usually isn't enough living matter that can stretch to reconnect. Patients who aren't seen quickly enough usually require a graft from a living nerve taken from elsewhere in the body.

"And when you have to use nerve grafts, the functional recovery falls off the map," Hansen said. "It would have meant a lack of function forever."

Another few hours and Cabrera would have required nerve grafts, ending his career. If he had stayed in the Dominican Republic another day, he would have lost sensation in his hand for the rest of his life. He might have lost the hand altogether.

"Any nerve cuts like the ones he had, you don't want to call it a nonrecoverable injury, but a full recovery is rare," Hansen said. "I don't know that we left the operating room thinking, 'We repaired everything, and hey, he's going to do great.' But we thought maybe, just maybe, he had a chance."