Teenager in Holguin saved by a doctor’s creativity

Death made rounds to a teenager about eight years ago. It was when the boy, a resident of the municipality of Banes, decided to demonstrate his skills as a “diver” by diving headfirst from a bridge into the river where he was enjoying his free time.

However, this teenager miscalculated the depth. The dizzying dive resulted in a brutal impact with the bedrock of the waterway. The result of the collision was a dislocated neck and severe fractures of the cervical spine. That, in popular parlance, means that he was “stripped naked”.

Fortunately, this teenager was quickly helped and was taken to the city of Holguín, where he was admitted to the Octavio de la Concepción y de la Pedraja Pediatric Provincial Hospital. There he was fitted with a device called Fronda de Glisson, designed for the traction of the spine in cases like this, but a few hours later, the device itself caused edema in the neck, and severe friction burns in the same region, a scenario to which the specialists were not unaware, because the medical literature warns that the device can cause this situation.

“That’s how I found him at the beginning of my medical shift. The problem created had to be eradicated and the teenager’s life saved. What to do? I didn’t think long and went to the hospital storeroom. In a ‘wartime’ suitcase, among many valuable items, I found a knee retractor, commonly used by orthopedics, and it occurred to me to make a transformation,” says Dr. Miguel Leyva Tamayo, a second-degree specialist in Neurosurgery, assistant professor of the specialty, associate researcher and Master’s degree in Medical Emergencies.

The modification, which required consultations with qualified personnel from the Department of Electromedicine, consisted of removing the elements that hold the knee and placing in their place metal rods from the adaptation of some from disused beds, which he took to a well-known self-employed turner, so that he could cut them to the agreed size and sharpen one of the ends.

“Once this was done, and the rods were added to the retractor, we proceeded to sterilize the assembly. Then we placed it in the patient. To do this, we made the two biparietal trephines of the external table of the skull bone, and began the process of retracting the cervical spine, placing weights according to the height of the fractured area.

“Subsequently, we increased the weight progressively, according to calculations that have to do with the patient’s weight and the height level of the fracture, until we had cervical distraction and alignment of the vertebral bodies, which favored recovery from the radiological point of view, to lead him to the surgical act in a second moment”.

This is how what is known today in the national neurosurgery scene as the Cranial Retractor for Cervical Luxofracture came about. It is a native innovation that, for many experts in the field, is great because of the simplicity of the solution and what it means to preserve the lives of children, teenagers and adults in a situation like the one described.

Proven effectiveness

Only the saved boy, his relatives and closest friends, as well as the medical personnel who follow him up, know that he is wearing a metal plate screwed in a part of his cervical spine. And the most important thing is that he walks through life without any disability.

“The cranial retractor has been used in three other patients. Two were saved. One was taken from us by death. The latter had dived headfirst into a pool with low water level, but arrived in a very complicated neurological state, i.e., quadriplegic. He had severe respiratory difficulties,” the leading specialist recalls with bitterness.

Asked to rate the innovation, he outlines what he considers to be its strengths. First, the patient is placed in the bed he/she occupies, without the need to take him/her to an operating room. In addition, local anesthesia is used and the procedure is performed using whole hair. Thus, it avoids shaving the entire head, otherwise there are always psychological effects on the patient. In addition, the exchange of the patient with the physician is constant during the installation, which leads to a favorable biosocial relationship.

“It is also reusable and has long durability. As for sterilization, it is possible by autoclaving or the use of disinfectant substances. For this reason, the risk of infection is minimal, and in its easy installation, few medical resources and expendable material are used in the patient. All that is needed is a syringe with local anesthetic and a scalpel to make a small opening in the skin of the skull, followed by a trephine in the external table of the bone”.

Wishes to become reality

Encouraged by colleagues who recognize the importance of the device and their own desires to relaunch it after its emergence, Leyva Tamayo presented it in the first half of this year at the Expociencia event, to which the solutions with which the province of Holguin faces various challenges are brought.

The jury, without hesitation, awarded him first prize in the innovation category. It also recommended the possibility of industrial-scale production, for which, among other things, the author admits, patent issues must be resolved.

This has given a new lease of life to the author, who admits that his dream of generalizing the use of the device has yet to come true. Today there is only one and the idea is to make two more, to be delivered to the Vladimir Ilich Lenin and Lucía Íñiguez Landín hospitals, in the province of Holguín. After that, the main hospitals of Las Tunas, Granma, Santiago de Cuba and Guantánamo would be built, where teenagers might be waiting.

The specialist recalls that, according to the rules and procedures of the specialty, every neurosurgeon must place this type of device, which does not reduce his willingness to provide the necessary training. It cannot be overlooked, he explains, that the Octavio de la Concepción y de la Pedraja Hospital is a reference center in the eastern region for complex surgical procedures on tumors and congenital malformations.

If people’s lives are at stake, why has the generalization of the innovation been delayed? What is expected to assume the recommendations of the jury of Expociencia 2023 on the possible serial production of the device? Why has the author had difficulty in accessing knee retractors to add the rods that make the cranial traction concrete? Will it have to do with the relatively low number of cases of neck dislocations and fractures of the cervical recorded in a general sense in Holguín, from 2014 until today ? wasn’t such a device already needed in the Clinical-Surgical Hospital Lucía Íñiguez Landín ? Public Health authorities should carefully assess this situation.

While that is happening, Dr. Miguel gets anxious when summer arrives. His experience tells him that this stage is propitious for the accidents suffered by the aforementioned teenagers. While he remains ready to provide specialized medical assistance, he prefers that parents and children reflect together on the impetuosity and inexperience of the latter, which can lead to unpleasant outcomes. That is why, among other things, he recommends paying attention to behavior in rivers and swimming pools.

By Germán Veloz Placencia (Granma newspaper) – Translated by Radio Angulo