Ghastly Accident Tests Skill of Doctors, Victim's Pluck : Medicine: Patsy Bogle's hair snagged in an industrial blender. Surgeons took five hours to reattach her scalp.

By SHERYL STOLBERG

May 6, 1994 12 AM PT

TIMES MEDICAL WRITER

It was a horrifying accident. Remarkably, Patsy Bogle remembers it all.

The 30-year-old mother of three was on the job at a Monrovia packaging company, cleaning sticky red silk screen residue off the blades of a giant industrial blender when her long brown ponytail snagged in the machine.

She felt her head smash into the metal and in an instant, her scalp was gone--torn off in a single piece, from her eyelids to the nape of her neck, including two-thirds of her right ear.

That was Tuesday morning. By the evening, in a delicate and extremely rare surgery, a team of doctors at USC University Hospital had sewed the woman back together. They say her prognosis is excellent.

Employing suture thinner than human hair and working with a microscope, the doctors stitched together arteries and veins to bring back circulation to the woman’s scalp, keeping the tissue alive. Finding them was not easy; nine of the 12 major vessels that bring blood to the scalp were destroyed in the accident.

The five-hour procedure was testimony not only to the wonders of modern microvascular surgery, but also to the remarkable calm of a woman whom friends describe as a “down-to-earth Kansas farm girl.”

By all accounts, Bogle kept her wits throughout her ordeal, up to the moment she went into surgery. When her husband arrived on the scene, as paramedics were preparing to take her to the hospital, she looked up at him and said simply: “I’m all right, Timmy. I’m all right.”

On Thursday, she told one of her surgeons about the accident. It was the first time she could recount what happened Tuesday morning to anyone other than her husband.

“I just remember hitting my head,” she said from her bed in the hospital’s neurosurgical intensive care unit. “I yelled at my boss, ‘Help me! Help me!’ I think I knew it was pretty bad. . . . I was afraid I was going to die.”

For doctors on the highly specialized microvascular surgical team, this kind of surgery is why they have spent entire careers in training. Over the last 12 years, a review of the medical literature shows, only 18 scalp replantations have been performed worldwide.

For Bogle, the meaning was much simpler: a chance to look the same as she always has.

Even had the surgery failed, she would have survived. But she would have required extensive grafting operations, where doctors most likely would have taken muscle from her back to cover her exposed skull. She would have been permanently disfigured.

“If you lose a finger or a thumb, there are other options,” said Dr. John Gross, one of two surgeons who performed the operation. “You have other fingers that work, or we can take a toe to make a thumb. For her injury, it is so catastrophic, it would be impossible to reconstruct her scalp to make eyebrows, an ear, or for her to have any more hair.”

Gross’ partner, Dr. Bala Chandrasekhar, predicted that Bogle would “have a very nice outcome. I think we made a big difference in her quality of life, a big, big difference, and that cannot be done by any other technique.”

Patsy Bogle never thought of her job at Ross Technical Associates as a career, and she wasn’t planning to stay there. The job didn’t pay enough, and she didn’t like being, as she says, “just a laborer.”

She and her husband had moved to Kansas, where they had gone hoping the environment would be better for her three children, but moved back to the Los Angeles area two months ago. Their two oldest children, 12 and 14, are finishing out the school year in Kansas, living with relatives.

Recently, Bogle had given notice to Ross Technical that this week would be her last. Next week, she was going to Kansas to pick up the kids and bring them back home to Arcadia. Then she would start a job as manager of a pizza parlor.

That was before Tuesday morning.

“It’s very difficult for me to talk about it,” says Larry Boehm, Bogle’s supervisor at the packaging plant. Just after the accident, he was the one who comforted her. Instinctively, he sat her down and rested his hands on her shoulders so that she would not fall. He looked closely at her scalp.

“It was the most incredible, bizarre thing I have ever seen in my life,” he said. “First she had hair and plenty of it. And then she had no hair.”

Fortunately for Bogle, the scalp was in one piece. Paramedics removed it from the blendingmachine, put it in a plastic bag, kept it on ice--a move that was crucial to keeping the tissue alive. Then they took Bogle to Huntington Memorial Hospital, but doctors there felt they were not expert enough to treat the extraordinary injury.

They sent her to USC University Hospital, a private facility affiliated with the university’s School of Medicine.

As soon as they saw Bogle, doctors there knew that time was crucial. In the cumbersome language of medicine, she had suffered a “scalp avulsion.” Scalp tissue will survive for 12 to 18 hours after being removed from the skull; Bogle’s operation began about five hours after the accident occurred and lasted into the 11th.

First, surgeons attached the lone remaining artery on the left side of Bogle’s head, making microscopic stitches to permit blood to flow once again to her scalp. When they removed their surgical clamps, her right ear began bleeding. This was a good sign, Gross said. “We knew we had blood getting in.”

Then came two veins, one on the left and another on the right. Once all three vessels were reattached, the surgeons had one final task--to sew the scalp back on her head. They sutured muscle, cartilage and skin, including the woman’s ear. Her hearing was not damaged in the incident.

The intricate operation cost an estimated $20,000. Although Bogle’s family has no health insurance, they have barely given a thought as to how to pay the bills. They hope the state’s workers’ compensation system will pick up the tab.

Patsy Bogle has not looked in a mirror yet; she says she is not ready to see herself, and for now, her family believes that is wise.

What she would see bears little resemblance to Patsy Bogle of a few days ago: a pretty, round-faced woman with clear skin and thick reddish-brown hair. Her eyes are swollen almost shut now, and stitches travel across her eyelids, underneath her right ear and around to the nape of her neck.

The right side of her head is badly bruised and her ear bleeds profusely. All this is to be expected. In fact, doctors say the bleeding is crucial in order to drain Bogle’s wound. To assist in the process, they applied leeches to her injured ear. The leeches--flown in from New York--secrete a chemical to keep blood from clotting. One doctor described them as having “magical properties.”

Although major obstacles have been overcome, Bogle still faces a few more hurdles.

She is likely to need minor plastic surgeries over the next few weeks, including an operation on her right eyelid, where skin is missing. And there is still the chance that the newly reattached blood vessels could close up, a threat that diminishes each day.

By Thursday, her swelling was starting to go down, and she ate her first breakfast--lime Jell-O and chicken broth. She is doing so well, doctors say she may go home next week. And in what her family sees as the most promising sign of all, her hair is starting to grow back.

Reattaching the Scalp

With microvascular surgery, a team of surgeons at County-USC Medical Center successfully reattach Patsy Bogle’s severed scalp. The unusual procedure took more than five hours to complete. Here is what they had to do:

1. Emergency personnel places Bogle’s scalp on ice, giving the surgical team 12 to 18 hours to execute the delicate surgical procedure.

2. In surgery, the doctors locate reattachable arteries and veins. They find three; the left superficial temporal artery and vein and the right supraorbital vein.

3. The artery and veins were reattached. This is the most delicate part of the procedure. The entire procedure is done under a microscope because arteries and veins are about a millimeter in diameter.

4. The scalp is then sewn back to the patient’s head.

Sources: Dr. John Gross, County-USC Medical Center; “Plastic and REconstructive Surgery”