Kauai Fire Captain Undergoes Rare Vocal Reconstruction After Foil Surfing Accident

Makali‘i Andrade, a Kauai Fire Rescue Captain, has regained the ability to speak following an experimental nerve-transfer surgery at Vanderbilt University Medical Center. The procedure addressed severe vocal cord paralysis caused by a 2022 foil-surfing accident that severed his trachea and damaged the nerves in his throat. Medical experts at Vanderbilt performed the complex, six-hour operation in May 2024, successfully rerouting nerves to restore function to his diaphragm and vocal cords.

How the Accident Occurred

In December 2022, Andrade was tow-in foil surfing off the coast of Hanalei, Kauai, when a maneuver went wrong. The wing of his hydrofoil board struck his neck, causing immediate and life-threatening trauma. Archie Kalepa, a veteran waterman who was present at the scene, assisted in the initial rescue. According to accounts provided to Hawaii News Now, Kalepa and other surfers helped stabilize Andrade on a rescue sled and transported him to shore. The rapid arrival of a trauma medic on the beach proved critical in preventing further respiratory collapse while Andrade was transported for emergency surgery to repair his severed airway.

The Medical Process of Vocal Reconstruction

While surgeons initially saved Andrade’s life by repairing his trachea, the secondary damage to his laryngeal nerves left him with long-term vocal paralysis. Initial attempts at healing failed because the nerves grew back incorrectly, effectively crossing the signals required for speech and breathing.

During the May 2024 surgery, Vanderbilt otolaryngologists Dr. Sarah Rohde and Dr. Alex Gelbard performed a specialized nerve graft. According to Dr. Rohde, the surgical team rewired nerves from the diaphragm—which controls lung movement—and connected them to the vocal cords. Dr. Gelbard noted that because nerves grow at an imperceptibly slow rate, the full functional recovery of Andrade’s voice is expected to take at least six months. Despite the long timeline, Andrade’s ability to speak shortly after the procedure indicates that the graft has successfully begun to integrate.

Risks and Safety in Hydrofoil Surfing

The injury highlights the increasing risks associated with hydrofoil surfing, a sport that has seen a surge in popularity. Unlike traditional surfboards, hydrofoils feature a sharp, wing-like structure that extends beneath the water. When a surfer falls, the board can become detached or move unpredictably, turning the foil into a dangerous projectile.

Key Facts About the Recovery

• Injury Date: December 2022.
• Surgical Location: Vanderbilt University Medical Center, Nashville, Tennessee.
• Procedure Duration: Six hours.
• Medical Goal: Re-innervation of vocal cords using diaphragm nerve branches.
• Recovery Outlook: Six months for significant functional improvement, according to the Vanderbilt surgical team.

Why This Case Matters

Andrade’s recovery represents a significant advancement in laryngeal reinnervation, a field that often deals with permanent vocal loss. By utilizing nerve grafting techniques typically reserved for more common trauma, the Vanderbilt team has provided a blueprint for treating similar high-impact neck injuries. For the surfing community, the incident serves as a stark reminder of the unique hazards posed by foil equipment, prompting ongoing discussions regarding the use of protective gear and safety protocols in high-speed water sports.