August 3, 2001
Firefighter Jason Emhoff is Upgraded to Satisfactory Condition
Seattle — Jason Emhoff, the firefighter burned in the Thirty Mile Fire in Okanogan County last month, was upgraded yesterday afternoon to satisfactory condition at Harborview Medical Center in Seattle. Emhoff was transferred out of the Burn Intensive Care Unit to the Acute Burn Center patient floor. If all goes as planned, his next surgery by Harborview surgeons will involve removing his left hand from the abdominal pocket and applying allograft, and autografting his ears and neck.
As background, on Monday, July 23 burn surgeons at Harborview determined that the burns to firefighter Jason Emhoff’s left hand were too deep to apply askin graft, that would successfully adhere and give his hand good function.Surgeons decided to cover his hand using the crane principle, which required that his left hand be inserted into his abdominal wall. If all goes well, the abdominal fat will adhere to his hand to provide a sturdy layer for surgeons to apply a skin graft at a later time.
Dr. Loren Engrav, professor of plastic surgery, and Dr. Lee Faucher, burn fellow, at Harborview, performed the flap procedure, which is done about once a year at Harborview. Engrav explained the hand functions rather like a crane in that it goes in to the abdomen to retrieve some fat before it is removed.
“The procedure has never become a common procedure for several reasons, ” says Engrav. “Number one, the injuries requiring this are uncommon; number two, many patients cannot tolerate the procedure; and number three, other methods have been developed over the years.”
Most burns are either shallow and require a skin graft or too deep and require amputation. Engrav says Emhoff’s hand is in between and makes a good candidate for the crane flap procedure.
The procedure consists of making a pocket under the skin in the patient’s abdominal wall. The pocket is cut like a glove and the patient’s hand is inserted into the glove for two to three weeks. After the hand is taken out it is then grafted with skin.
“With the crane flap procedure, the hand comes out with the fingers separated and covered with a little fat and is then grafted so the hand is functional,” says Engrav.
The doctor who first performed the procedure is Dr. Ralph Millard, who wrote an extensive article on the crane procedure in a 1969 Journal of Plastic and Reconstructive Surgery.
Jason, 21, from Yakima, arrived via Airlift Northwest at Harborview Medical Center on the evening of Tuesday, July 10, 2001. He suffered about 30 percent burns over his body to his face, hands, ears, arms and legs. The deepest burns occurred over his hands.
Since its opening in 1974, the UW Burn Center at Harborview has treated more than 9,000 patients from the four-state region of Washington, Alaska, Montana and Idaho. The overall mortality rate at the Burn Center stands at four percent. The program’s effectiveness is due not only to advances in technology, but to its team approach including general surgeons, plastic surgeons, physical and occupational therapists, social workers, specialized nursing staff, psychologists, vocational rehab therapists, a dietitian, a pharmacist and special teams in the operating room.
Media: For an illustration that depicts the crane flap procedure, please contact Susan Gregg-Hanson at 206-731-4097.
Contributors: Katie McCarthy and Susan Gregg-Hanson.
