Plastic surgeons reconstruct NFL star Alex Smith's leg and dreams

NFL star Alex Smith's life changed in a matter of seconds in 2018. One moment the quarterback was running toward the 40-yard line, and the next he was steamrolled to the ground by the opposing team's J.J. Watt and Kareem Jackson. The tackle shattered the bones in Smith's lower leg – and potentially his dream of ever playing football again.

"You just never expect something like that's going to happen to you," said Smith. "To look down and see your leg bending where it shouldn't. The realization that obviously my leg was pretty severely broken."

A crushing diagnosis

Doctors diagnosed Smith with an open fracture of his tibia and fibula, and set their sights on putting his lower leg back together. The surgery went as expected, and Smith was on the road to recovery. It seemed like it was only a matter of time before Smith would be discharged from the hospital and return home to his wife and children.

Then, the unexpected happened. A high fever gripped Smith. Soon after, doctors found bacteria in his blood. Smith had an infection. He lay septic and delirious in a hospital bed with his wife at his side. She no longer worried for her husband's leg but for his life, as sepsis is an emergency medical condition requiring swift treatment.

An infection that could kill him

Doctors unwrapped Smith's bandages and found his leg had turned black. They rushed him back into surgery, which revealed that necrotizing fasciitis was eating his flesh. Now the focus was on saving his life. To do so, doctors removed the infection in his leg and cut out a large area of muscle and skin, exposing the entire length of his tibia from top to bottom.

"They got the infection under control in that sense, but (thought) maybe they still needed to cut off my leg," said Smith. "At that point, that's when I got introduced to Dr. Mehan. He was the doctor explaining that maybe he could save my leg."

Plastic surgeons work to save his leg

Smith's main concern was retaining the function of his leg so he could continue to play with his kids. So, he put his future in the hands of plastic surgeon Vineet Mehan, MD, who led a team of surgeons that took muscle, fascia, fat and skin from Smith's thigh to reconstruct his shin.

Dr. Mehan recalled the moment he realized Smith's leg was indeed salvageable and said so out loud to his team of co-surgeons.

"I remember talking to my partners and saying, 'Listen, I have an acceptable vessel here for a target. We can keep going,'" said Dr. Mehan. "That was a real turning point for me in the surgery, that we had a really good shot of making this work in that we were covering the bone and the hardware, and he would potentially keep his leg."

His leg is saved

The surgery was successful. Keeping his leg was a dream come true for Smith and seemed like enough at the moment.

"Certainly, playing tackle football again, that was completely out of the question," said Smith. "I got made aware of what's called the secretary of defense designation, and it was for civilians that had what was deemed warlike injuries, and they could potentially get access to military care even though they were civilians."

Smith remembers being surrounded by patients whose injuries were more severe than his, and their bravery opened his eyes to a brighter future than he had imagined. With time, his leg got stronger, and so did his desire to return to football, which he voiced to those around him.

"I'm saying out loud that I want to go see if I can play football again," said Smith. "And I was scared to death when I said it. But really, the example that they set, I wasn't scared to try."

Returning to the NFL and beyond

Doctors eventually cleared Smith to return to football. He started the 2020 season on the injured list, but within just a couple of months, Smith was back in the game and helped take his team to the playoffs. By 2021, he was voted NFL Comeback Player of the Year.

He has since retired from football. Smith now spends his time as a motivational speaker, ESPN broadcaster and philanthropist, helping foster teens to transition into adulthood successfully.

Dr. Mehan nominated Smith for the 2022 Patients of Courage awards. Smith embodies the program's spirit, which seeks to recognize exceptional people who overcome difficulty, give back to their community and inspire those around them.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.