Ex-Formula One driver Alex Zanardi, who had both legs amputated in a motor racing accident almost 20 years ago before going on to become a Paralympic champion, was in an "extremely serious condition" in hospital on Friday (19 June) after crashing into a truck while competing in a handbike race in Italy.
Zanardi was participating in one of the stages of the 'Obiettivo tricolore' relay race in Tuscany when he lost control of his bike on a hairpin bend and crossed into the path of an oncoming truck near Montalcino.
The 53-year-old was airlifted to hospital in nearby Siena where he underwent emergency surgery for serious head and facial injuries before being transferred to intensive care.
"Due to the serious head injury, the neurosurgery and maxillofacial intervention began shortly after 19:00 and ended shortly before 22:00," the hospital said in a statement.
"The patient was then transferred to intensive care. His condition is very serious."
On Saturday, Zanardi remained "intubated and on artificial respiration" and his "neurological picture remains serious," the Santa Maria alle Scotte hospital said.
"The conditions are stable, but the neurological damage is serious and uncertain, and instability and deterioration may be possible."
Neurosurgeon Giuseppe Olivieri, who carried out the operation, described Zanardi's condition as "very serious".
"He arrived with significant crano-facial trauma," Olivieri told journalists.
"Concretely, all the bones of the face are fractured. He also has fractures on both sides of the frontal bone.
"At the moment, we are not talking about his neurological state. This is something that we will see later, when he wakes up and if he wakes up.
"The patient's situation is serious, that is to say that he can also die. In such cases, the improvements are slow, while the worsening can be brutal," he added.
'Don't give up'
Messages of support poured in for the former Grand Prix driver who twice won the CART championship in the United States, before having both his legs amputated following an accident on the Lausitzring track in Germany in 2001.
He went on to win four gold medals on his handbike in the 2012 and 2016 Paralympic Games, and two silver medals, and multiple world championship titles.
Mario Valentini, coach of the Italian Paracycling national team, told Corriere Della Sera newspaper: "Alex lost control of the handbike, rolled over twice and collided with a trailer truck. The collision was terrible."
Italy's Zanardi was a former Grand Prix driver who twice won the CART championship in the United States before having both his legs amputated following an accident on the Lausitzring track in Germany in 2001.
He went on to win four gold medals on his handbike in the 2012 and 2016 Paralympic Games, and two silver medals, and ten world championship titles.
"I am so anxious and frightened about Alex Zanardi that I'm holding my breath. I am his fan. I am his friend," tweeted former world Formula One champion Mario Andretti.
"Please do what I'm doing and pray pray for this wonderful man."
Zanardi's life changed forever on 15 September, 2001 when he crashed at 320km/h at Lausitzring while taking part in a CART race.
But what could have been the end of the sports career for the former Lotus and Williams Formula One driver from Bologna proved to be the start of another.
Zanardi adapted to his prosthetic legs and was back competing in the final race of the European Touring Car Championship at Monza in 2003 driving for BMW.
"Although the situation was really bad at the time, I set myself the goal of leading a normal life again at some time in the future," Zanardi said at the time.
"Today, I can walk, I swim, I go skiing."
In addition to his Paralympic medals, Zanardi also competed in the gruelling Ironman triathlon in Hawaii in October 2014.
He had been due to compete in the Paralympics in Tokyo this summer before they were cancelled until next year.
His most recent feat was last September when he achieved a new Paralympic triathlon world record time at the Ironman of Cervia, Italy of 8 hours, 25 minutes and 30 seconds.
It was a record which he achieved a few days after the conquest of two gold and a silver medal at the world championships in London.
"Alex is one of life's truly inspirational people and as we all know, a fighter through and through. Stay strong and Forza Alex," his former Williams team wrote on Twitter.
"Alex has already had his share of bad luck, which he transcended with a mighty determination and spirit to win again," said former F1 driver Martin Brundle.
"Let's hope he's fine and this is nowhere near as serious as it sounds from reports."
Zanardi raced for Jordan, Minardi and Lotus in Formula 1 in the early 1990s before switching to the CART championship in the United States where he was series champion in 1997 and 1998.
He returned to F1 with Williams in 1999 before heading back to the CART series.
Zanardi's passion remained motor racing and he had just announced he would drive a specially-adapted BMW in the final endurance round of this year's Italian GT Championship at Monza in November.
"I can't wait to get back in a car," he said.