Tendon repair and nerve graft save Dan’s foot after chainsaw accident

As Dan Rustan, of Iowa City, Iowa, used a chainsaw to take down the remains of a large tree that had been snapped in half by the devastating derecho that swept across Iowa in August 2020, the tree fell more quickly than he expected. The trunk kicked the chainsaw back, and the saw caught Dan’s lower leg.

A quick-thinking neighbor applied a tourniquet to slow the heavy bleeding in the two large gashes in Dan’s leg. Dan was then rushed by ambulance to University of Iowa Hospitals & Clinics.

Dan Rustan and his dog
Complex surgery, including a nerve graft, saved Dan’s right foot after a freak chainsaw accident.

Orthopedic surgeon Brendan Patterson, MD, performed surgery to clean and close the wounds. Three days later, orthopedic surgeon Joseph Buckwalter V, MD, reattached severed tendons and completed a nerve graft.

Two months later, Dan, 58, was walking in regular shoes and making plans to get back into running and playing basketball with his sons.

“I have my foot, I’m walking, and hopefully I’ll be able to run again,” Dan says. “I’m so happy with how things have worked out and thank God every day.”

A team of UI Health Care experts waiting for him at the door

Dan knows how fortunate he has been throughout his experience with UI Health Care—from his arrival in the emergency room to the surgery and follow-up care that have helped him do the work to reach his goal to return to running.

“On the way to the hospital, the EMT in the ambulance told me not to be concerned about all the people who would be right there when the ambulance doors opened,” Dan says. “He reassured me they were all there to help me. He was right. Everyone has.”

Patterson assessed the damage to Dan’s leg during the initial surgery to repair the wounds. The tibial artery had been cut. The tendons and nerves leading to his foot had been severed. The saw had also chipped a bone.

During the surgery to repair the leg, Buckwalter completed a nerve graft using donated nerve tissue. He also reattached three tendons.

Hours later, Dan went home with crutches. A cast kept his ankle and foot in position to heal properly.

Taking the first steps toward success

After the second surgery, Dan told Buckwalter how much he enjoyed running and that he wanted to get back to it.

Buckwalter told him it was a realistic goal, but he also tried to help Dan set his expectations. Nerve damage might mean running wouldn’t feel the same as it did before, Buckwalter told him. He also let Dan know that in rare cases, the foot can’t be saved.

Dr. Buckwalter is upbeat and positive, but he tells you straight up what the options are, giving you the good and the bad. He’s an expert in limb salvation. I was happy the timing worked out so he could do the surgery.

— Dan Rustan

A month after surgery, the cast was removed and replaced with a boot that allowed Dan to walk without crutches. He put the foot to work immediately.

“I started logging 1,000 steps a day without crutches, building up to 3,000 steps a day within a week,” Dan says.

Physical therapy is helping strengthen muscles and improve range of motion in his foot and ankle. He doesn’t have sensation in the bottom of his foot, but he knows it can return over time.

Now, just months after he nearly had his foot severed by a chainsaw, Dan’s looking forward, eyeing a goal that for at least a few days last August may have seemed unthinkable: preparing to run in the Iowa City Road Races Run for the Schools event in October 2021.

“I’m optimistic I’ll get there when my body’s ready,” he says. “I may not be running a marathon, but I’ll get enough in for a cardio workout.”

Iowa City, Iowa