Nerve Transfer Enhances Arm And Hand Movement
Michael Reeves, 38, of Red Bud, Illinois, injured his C5 and C6 vertebrae in an ATV accident in 2000, leaving him an incomplete quadriplegic. He could use his arms and hands well enough to drive, but could not use his hand to pull a ticket at the entrance of a parking garage or carry out other basic functions.
In 2013, Reeves’ neurologist referred him to Washington University plastic and reconstructive surgeon Ida Fox, MD, who performed surgery to reroute working nerves in the upper right arm. These nerves can now “talk” to the brain because they attach to the spine above the injury. Reeves says it took 13-14 months to regain movement, but he can now grasp silverware, pick up items in a grocery store — and pull a parking ticket. He also has greater dexterity to enjoy his hobbies: deer hunting and riding ATVs.
“Physically, nerve-transfer surgery provides incremental improvements in hand and arm function. However, psychologically, these small steps are huge for a patient’s quality of life,” says Fox.
The surgery was developed by Susan Mackinnon, MD, division chief and the Shoenberg Professor of Plastic and Reconstructive Surgery. Like railroad switchmen, the focus is on rerouting passageways; but instead of trains on a track, surgeons redirect peripheral nerves in a quadriplegic’s arms and hands by connecting healthy nerves to the injured nerves. Essentially, the new nerve network reintroduces conversation between the brain and muscles that allows patients, once again, to accomplish tasks that foster independence.
Fox and Mackinnon recently assessed the outcomes of nerve-transfer surgery in nine quadriplegic patients.* Every patient in the study reported improved hand and arm function.
Fox hopes to reach more patients with cervical spine injury. She is evaluating patients at the VA St. Louis Health Care System, which serves more than 250 patients with cervical spinal cord injuries in a five-state area. She also drew specialists nationally for a 2014 seminar and traveled to Canada to help perform the country’s first nerve-transfer surgery for cervical spinal cord injury in 2015.
*Fox IK, Davidge KM, Novak CB, Hoben G, Kahn LC, Juknis N, Ruvinskaya R, Mackinnon SE. Nerve transfers to restore upper extremity function in cervical spinal cord injury: Update and preliminary outcomes. Plastic and Reconstructive Surgery. October 2015.
Division Chief Susan Mackinnon, MD, is working with staff scientist/videographer Andrew Yee to develop an online educational program focused on nerve surgery. The project has evolved from a website created by Ida Fox, MD, Mackinnon and Yee — nervesurgery.wustl.edu. It offers videos that present evaluation guidelines and case studies and demonstrations of peripheral nerve procedures. The new program allows for better quality video and will provide more information on identifying patients who need surgery. Videos eventually may include extensive information on postoperative care and rehabilitation.
Kamlesh Patel, MD, who specializes in craniofacial and general pediatric plastic surgery, is investigating the ability of MRI to produce 3D-reconstructed images of the cranium as a project in his master of science in clinical investigation degree program at Washington University. Currently, physicians use CT scanning to create 3D-reconstructed images for surgical planning and outcome assessment. Using MRI instead would provide imaging without exposing children to radiation, which has been linked to increased risk of brain cancer and leukemia.
Amy Moore, MD, was named program director of the Washington University Hand Surgery Fellowship. The fellowship, one of few such programs in the country, received 27 applications for two positions in 2016-2017.
Donald Buck II, MD, has established a vibrant plastic surgical service at Christian Hospital in north St. Louis County. New faculty member John Felder, MD, a recent hand fellowship graduate, will expand services to nearby Alton Memorial Hospital in Alton, Illinois.