San Diego Bay Tragedy Ends in the Pink

Carl Mayerhofer lost his left arm Saturday on a barge in the middle of San Diego Bay. By mid-afternoon Sunday he had it back: pink fingers, warm flesh, and a steady pulse.

In between, two friends bundled him into a tiny skiff, headed for shore on the strength of a 6-horsepower engine--and ran out of gas before reaching the pier.

Then a fireman motored back out to the barge, found the arm, and carried it to waiting paramedics. Finally two doctors at UC San Diego Medical Center performed a 14-hour “replantation,” done almost entirely with the aid of a microscope.

“The fingers are warm and pink and appear normal,” Dr. Michael Botte reported late Sunday, after visiting Mayerhofer. “His pulse is intact at his wrist, which means we’ve reestablished a good blood supply.”

Mayerhofer, described as a self-employed salvage worker in his mid-30s who lives on a barge on San Diego Bay, was working with two friends about 12:30 p.m. Saturday, trying to lift an aluminum boat off the bottom of the bay 500 feet off the Chula Vista shoreline, according to police.

Suddenly, there was a loud grinding from the crane that Mayerhofer was operating aboard his barge, one of the friends told police. The crane’s boom swung around and struck the mast of a boat that had been tied up to the barge, the man said.

“Then he saw Mayerhofer lying on the deck of the barge on his back. He heard Mayerhofer yell, ‘Help me, help me, help me,’ ” said Officer Robert Mickschl of the Harbor Police. “He saw Mayerhofer’s left arm had been severed.”

Mayerhofer’s friends tried to staunch the flow of blood from the wound, just below Mayerhofer’s shoulder, and fashioned a tourniquet out of some old silk cloth, Mickschl said. Then they loaded him into a small motorboat and headed for shore.

Somewhere en route they ran out of fuel, but were able to refill the tank with fuel on board. Encountering another boat, they asked for help. The boaters radioed to the Coast Guard for help. Harbor Police heard the transmission and contacted Chula Vista police, and Mickschl headed for the Chula Vista Marina.

There, a Life Flight helicopter had arrived and paramedics were tending to Mayerhofer. A Chula Vista firefighter found a boat and rushed back out to the barge, found the arm on the deck, and brought it back to shore.

The helicopter lifted off for UCSD Medical Center at 1:25 p.m.

Botte, the 32-year-old acting chief of the orthopedic hand and microvascular surgery program, was working in the anatomy laboratory at the UCSD main campus when the call came in. At 2 p.m., he and Dr. Mark Silver began the operation.

Within 30 minutes, they reestablished the blood supply to the arm by attaching a plastic tube to the major artery in the stump, Botte said. Then they repaired the broken bone with the help of a six-inch stainless steel plate and screws.

Next, they transplanted veins from Mayerhofer’s legs into the arm to repair the principal artery and four major veins. They reattached the four major repairable nerves, though extensive nerve damage may necessitate additional surgery.

Muscle and tendon repair followed, Botte said, and skin recovery using grafts of skin from neighboring parts of Mayerhofer’s arm. Throughout the operation, Botte and Silver worked together, peering through the eyepieces of a seven-foot-high, overhead microscope.

“It was a very severe injury,” Botte said, pointing out that the wound was jagged and Mayerhofer was in critical condition, with other injuries to his face and chest. He received about 11 liters of blood during the operation to make up for his extraordinary blood loss.

The operation did not end until 4 a.m.

Mayerhofer remained in critical condition Sunday evening.

Botte said his team has performed three arm replantations, one hand replantation, and 30 digit replantations in the last nine months, including Mayerhofer’s. He said that in 80% to 90% of all cases, the limb survives.

If Mayerhofer’s arm survives, and avoids the kind of clotting and infection that jeopardize such cases, Botte said Mayerhofer may well regain sensation and some motor function. But there will always be weakness and additional operations may be required, he said.

However, had the arm not been retrieved, Botte said, “He would have ended up with a more or less short-stump shoulder--an amputated arm just below the shoulder joint.”

It remained unclear Sunday precisely how the accident occurred. Mayerhofer’s friends told Mickschl that the spool holding the cable for the crane would stick occasionally if there was too little weight on the cable. “He said it’s a common practice to turn the drum by hand to get it to work,” Mickschl said.