“At first, the procedure sounded crazy. Nobody had even mentioned it as a possibility”
Bruce Panczner and his two companions weren’t lost, exactly, but they were in trouble. The sun was setting and their GPS devices stopped working because the temperature had dropped rapidly. They decided to stay put for the night rather than venture any deeper into the treacherous terrain of the Rocky Mountains.
A big part of the allure when they signed up for this back-country snowmobile and snowshoe wilderness trip in Colorado was the thought of existing off the grid for a few days. Now that isolation was coming back to haunt them.
“We dug a small snow cave in a ravine and spent the night in there,” Bruce says. Or, at least, his companions did. Before they hunkered down for the night, Bruce managed to reach the local sheriff’s department on a satellite phone, and he conveyed the basic details of their situation and location before the called was dropped. “So, I was holding out hope that our rescuers were on the way,” he says. Bruce hiked out of the ravine and spent four hours trekking from crest to crest looking for them. “But, understandably, no one ever came.”
Throughout the night, Bruce’s main concern was not on his own health, but that of his nephew, who he thought was starting to show signs of severe hypothermia. Thankfully, all three made it through the night and were found in the morning after an exhaustive search by the sheriff’s department. Though, they were still far from home, literally and figuratively.
At the hospital, Bruce was diagnosed with extreme frostbite of his forefeet, toes, and heels. A surgeon recommended amputating both of his legs below the knees, but Bruce resisted. He spent the next month in the hospital in constant pain. “On a scale of one to 10, it got as high as a 10. At that point, you’re either going to pass out from the pain or die,” he says. “But they were pretty effective at managing my pain. It never went below a two or a three, however.”
During that time, Bruce was transferred to another hospital in Colorado and pitched alternative treatments, “but,” he says, “loss of limb was still the end game.”
Bruce could not come to terms with the prospect of amputating his legs. Finally, he decided to return home to Pennsylvania and explore other options. A close friend referred him to L. Scott Levin, MD, FACS, FAOA, Chair of Penn Orthopaedics, Paul B. Magnuson Professor of Bone and Joint Surgery, Professor of Surgery-Division of Plastic Surgery, and co-director of the Penn Orthoplastic Limb Salvage Center.
Dr. Levin proposed a vastly different approach. “I remember sitting there as he told me he was going to attach tissue from my arms to my feet,” Bruce says. “At first, it sounded crazy. Nobody had even mentioned it as a possibility. But, as I’d come to learn, there was a reason for that: Dr. Levin is one of a limited number of surgeons in the world who could even do it.”
Starting over
“He was at risk of losing both of his feet due to necrosis,” Dr. Levin says. “We salvaged almost his entire foot on both his left and right sides by performing a microvascular tissue transfer. This involves taking living tissue, with its blood supply and artery and vein, from Bruce’s upper arms and transplanting living skin and tissue to his feet.”
In April 2016, Dr. Levin had to start by amputating Bruce’s forefeet and all 10 of his toes, which were too damaged by necrosis to be salvaged. The next day, however, he performed the microvascular tissue transfer - a 10- to 11-hour surgery. “As I understood it, they wanted to transfer as much tissue as possible to encourage circulation,” Bruce says. “After the tissue is accepted—it may or may not be; mine was, fortunately—then they’ll go back and ‘de-bulk’ the tissue.”
‘I’m actually better’ than I was
Four years later, Bruce marvels at the normalcy of his life. “I work in property management across three states, so I’m always on the go,” he says. “Dr. Levin truly saved my life. I have two heroes: my dad and Dr. Levin. I can walk now. If you didn’t know I had this done, you’d never know. I can’t begin to describe how thankful and blessed I am for what Penn Medicine did for me.”
Dr. Levin expects Bruce to lead a relatively normal lifestyle. But, given all that he endured, including facing the very real possibility of having both his legs amputated, normal feels extraordinary.
“Am I 100 percent? No. I’m actually better,” he says. “Everything that’s happened since that trip has completely changed me. I like to say the net result of Bruce Panczner is so much better from A to Z than the guy who left for that trip.”