Young patient’s recovery from infection, multiple amputations, moves to next phaseNov. 21, 2023, 1:37 PM
by Jessca Pasley
After 143 days in the Pediatric Intensive Care Unit at Monroe Carell Jr. Children’s Hospital at Vanderbilt, Mathias Uribe was discharged to begin the next phase of his recovery.
As the transport team made its way down the hallway to the elevators, members of his care team donned celebratory hats, clapped, held up congratulatory signs, blew bubbles and shouted well wishes to the 15-year-old and his family.
“We love you all so very much,” cried Catalina Gutierrez, Mathias’ mother, as she hugged her hospital family.
Mathias’ hospitalization for a very rare sequence of health issues attracted a flurry of media attention. In late June he had flu-like symptoms that worsened, developing into bacterial pneumonia with an invasive streptococcal infection and septic shock.
The progression of his illness was highly unusual. Prior to becoming sick, Mathias was a healthy, rising high school freshman who enjoyed cross-country and playing the piano.
His critical state required the use of ECMO, or extracorporeal membrane oxygenation. The life-sustaining mechanical system temporarily takes over for the heart and lungs of critically ill patients, allowing their organs to rest and recover by removing carbon dioxide from the blood, replacing it with lifesaving oxygen, and returning it to the patient’s circulatory system.
Mathias spent two weeks on ECMO, which saved his life. Unfortunately, his hands and legs did not receive enough blood and required amputation.
“He has faced adversity with unwavering courage, and we have no doubt that he will continue to do so throughout this journey,” said his father, Edgar Uribe. “We are in awe of his unwavering spirit and determination, which will undoubtedly guide him through the challenges that lie ahead.”
Mathias, accompanied by his mother, took a two-hour medical transport flight for his next phase of treatment.
“It’s exciting but also very scary for us. We are looking forward to this, but we don’t know what to expect,” said Uribe. “We have heard really good things. We have spent so much time at Monroe Carell, and the staff has really become family.
“It’s been amazing to watch the bond that formed between Mathias and his primary nurse. It was good for him and really impactful for us as his parents. The team here has always looked at how best to help Mathias and do what is best for him.
“He’s focused on this next phase of the journey.”
Uribe, who tackled the seven-hour drive to the rehabilitation facility with his youngest son, Nicholas, said he owes Mathias’ recovery and quality of life options to the Monroe Carell surgery team.
The team worked meticulously, which involved many lengthy and complex operative procedures, to ensure Mathias was afforded optimal chances for prosthetics.
“Mathias developed necrosis of all four extremities that also involved the skin,” said Laxminarayan Bhandari, MD, assistant professor of Plastic Surgery at Monroe Carell. “It was important to us to try to salvage his joints and save as much tissue as possible to allow him the opportunity for the most function and better prosthetics options.”
To successfully salvage the joints, the team needed to use a procedure called a free flap that involves taking muscle from the patient’s back and attaching it to the knee by connecting the very small blood vessels of the muscle to even smaller blood vessels around the knee.
“We had extensive conversations with his family about the best way to move forward. While his surgeries were very challenging, we are so happy he has done so well.”
Mathias was treated much like a burn patient, as 50% of his body surface skin was lost.
“It was similar to a patient with fourth-degree burns,” said Elizabeth Slater, MD, associate professor of Plastic Surgery at Monroe Carell. “His injury from the effects of sepsis was one of the most severe I had seen.”
After his amputations, the team used some of the most innovative techniques to replace his skin, including Biodegradable Temporizing Matrix (BTM), a synthetic device that helps regenerate new tissue for wound closure and reconstruction of complex wounds, and the RECELL System, an autologous cell harvesting device that prepares, produces and delivers a regenerative cell suspension, Spray-On Skin Cells, using a small amount of a patient’s own skin. The Spray-On Skin Cells contain a combination of single living cells that stimulate healing and repigmentation throughout the wound bed.
“My goal was always independence for him, and his degree of injury threatened that,” said Slater. “We are fortunate to have a multispecialty plastic surgery team.”
Slater complimented the PICU team, who was not accustomed to the complexity of wound care that was required for Mathias’ recovery.
Now that Mathias is in the rehabilitative segment of his recovery, Slater is looking forward to the day she sees her patient walk back into the hospital for a visit.
It’s a vision that his family is also hopeful to witness.
“Mathias is very excited, but a bit anxious too,” said Uribe. “We’ll get to the rehabilitation facility, get strong and learn how to use the prosthetics. There’s the potential that he could walk out of there.”
The experience has taught the family how fragile life can be.
“My wife has said time and time again that everyone looks at this as a loss. We look at it as a gain,” said Uribe. “No one thought he would make it through the night. Yes, he lost his limbs, but he is still here. He motivates us. I cannot wait to see what he will do.”