WEDNESDAY, June 23, 2021 (HealthDay News) -- You might not believe it, but Florida firefighter Carsten Kieffer was incredibly lucky when a 12-foot alligator leapt into his boat and chomped down on his right forearm.
Just about no one else thought so, and that went double for Kieffer: Both main bones in his arm were broken, and a big bite had been taken out of the back of his forearm. After the attack, the arm essentially dangled from whatever muscle was left.
"I knew going in I was probably going to lose my arm," he recalls. The medics who initially treated him were just as doubtful of his prospects.
But thanks to the specific type of damage the gator did to his arm — along with talented surgeons and tough work in rehab — Kieffer returned to active duty with the Tavares Fire Department in April, a mere eight months after the attack.
He was fortunate the gator bit him where it did, sparing nerves, muscles and tendons that were essential to his recovery, explained Dr. Karan Desai, the hand and upper extremity surgeon who treated him at Orlando Regional Medical Center.
"I've still got a bit of a road ahead of me to get back to full fitness, but it's getting better every day," said Kieffer, 42, of Grand Island, Fla. "There are some days I don't even realize my disability or my injury."
The incident happened in August 2020, while Kieffer was hunting alligators with some friends at Lake Jesup.
The Florida Fish and Wildlife Conservation Commission estimates that the 16,000-acre body of water near Sanford, Fla., contains an estimated 13,000 gators, according to the Orlando Sentinel. Only the mighty Lake Okeechobee contains more alligators in the state.
The men snagged the reptile with a 12-foot-long snatch line, and then stuck it with two harpoons to bring it closer to the boat, Kieffer said.
Unfortunately, they were in shallow water, which gave the gator some leverage to fight back.
A sudden attack
"He was able to push off the bottom and launch himself into the boat," Kieffer said. "I was holding onto a couple of ropes that were attached to the harpoons that we got into the alligator to catch him. I was standing in the boat, holding onto the ropes, and he just came back and snapped and he got a hold of my arm."
Kieffer's friends sprang into action, one grabbing hold of his pants and the other sliding a metal pole into the gator's mouth to try and pry it open.
The gator "shook his head once and he lifted my body 6 to 8 inches out of the boat. That's when I could hear the skin rip and the bones snap," Kieffer said.
The attack ended on the gator's terms. "He just let go, and went back in the water," Kieffer said. "We cut the lines and we were off to find help."
It so happened that this was Desai's first day on call as an attending physician at Orlando Regional Medical Center. Fresh from medical training in New York, Desai was pretty sure someone was kidding him when another doctor called him in to treat Kieffer.
"One of the residents came to me and said, 'We have a patient that had an alligator basically bite off his arm,'" Desai said. "I thought it was a joke at first because I was new to Orlando Health and I thought they were just giving me a hard time as the new guy. But then they showed me the x-rays and the pictures."
Doctors initially gave Kieffer little hope that his arm could be saved, but Desai — trained in top trauma centers in Atlanta and New York — held off on that verdict. Maybe he'd never seen a gator bite, but he'd helped treat countless limbs mangled in car accidents and industrial mishaps.
"I don't make any quick judgments in the ER when I see these patients," Desai said. "I think every patient deserves a look in the operating room, to have them asleep and take a really close look at everything before making any decisions about things like amputations."
The bite had torn away just about all the muscle on the back of Kieffer's forearm, and broken both bones. "The arm was essentially hanging off on whatever muscle was still present there," Desai said.
Desai had three initial concerns, starting with damage done to the limb by blood loss. "There was some concern initially that the hand had no blood flow and it was looking dark and dusky," he said.
Blood loss, nerve damage and infection
The surgeon also was concerned that the nerves to the hand had been severed by the bite, which would block Kieffer from fully recovering function.
And finally, there was the risk of infection.
"The mouth of an alligator is full of copious amounts of bacteria, being in a swampy environment," Desai said. "A lot of alligator bites have led to amputations because no matter what was done, they couldn't clear the infection that was present there."
Luck was on Kieffer's side when it came to the damage done. Many blood vessels were impacted but easily repaired, Desai said, and because the bite was on the back of the forearm it didn't sever the two nerves responsible for the majority of a person's hand function.
Those are located on the top of the forearm, and they were "bruised but intact," Desai said. "They were not cut, so that was very, very lucky. If you could choose a side to do the most damage, you would choose" the other side, he added.
Desai started by stabilizing the bones, fixing the fractures with two plates and 17 screws. He then extensively cleaned the damaged tissue in the arm, washing out the wound and removing "anything that was not alive and looked like it was contaminated," Desai said.
Muscles that make the fingers and wrist flex had been torn away by the gator, but the top part of the forearm had been spared to the point that Desai could steal tendons from there and move them to the bottom of the forearm.
"I shifted them to the back of his arm and reconnected them to the tendons on the back of the arm to make his fingers go up and to make his wrist go up," Desai said.
Eight months later, back to firefighting
It took more than 20 hours of surgery, by Desai's estimate, and even then it wasn't certain that Kieffer would regain much function. Kieffer wound up spending 11 days in the intensive care unit, and lost count of his surgeries.
"The goal of everything would be me to be able to lift a glass of water and drink out of it," Kieffer said. "That would be a good goal."
Kieffer wanted to go back and resume his work as a firefighter, however, and so he threw himself into his rehabilitation work. Rehab appointments were three times a week, but he made his recovery a daily job.
"Every time they gave me a new workout to do, I went home and I bought the workout equipment so I could work out every single day," Kieffer said.
"Mr. Kieffer is one of the most motivated patients I've ever had," Desai said. "He gave 150% in rehabilitation, and he's actually starting to feel a lot of strength."
Kieffer's recovery was such that Desai cleared him for active duty in April.
"I can lift whatever I want to. I can do pretty much anything that is needed," Kieffer said. "The only thing that I can't do, flex my wrist back all the way yet, but it's coming. It's getting better and better."
There's one thing he won't ever do again, however.
A network of alligator hunters have vowed to track down the gator that bit Kieffer. He won't be joining them out on the lake.
"I thought I would never be able to pick up my daughter again or play catch with my son, so those are things I will never again take for granted," Kieffer said. "My kids were pretty traumatized when the attack happened and I have promised them that I won't be hunting alligators anymore."
The Florida Fish and Wildlife Conservation Commission has more about alligators.
SOURCES: Karan Desai, MD, hand and upper extremity surgeon, Orlando Regional Medical Center, Orlando, Fla.; Carsten Kieffer, 42, Grand Island, Fla.