Treating nerve injuries with new surgical procedures
The human nervous system is frequently compared to a city power grid. As is the case with a powerline, when a nerve strand is damaged, a portion of the system “goes off-line” and function is reduced or lost entirely.
While linemen have been successfully repairing power lines since the creation of power grids, neurosurgery to repair damaged nerves is relatively new. And newer techniques emerge all the time, leading to better surgical outcomes for patients with nerve injuries.
In Idaho Falls, Dr. Jhade Woodall is performing some of these newer surgical techniques at Eastern Idaho Regional Medical Center (EIRMC). He is specially trained as a plastic surgeon to treat nerve damage in the hands and arms.
Surgical treatment for neuromas
“Any time a nerve heals, it causes scar tissue,” Dr. Woodall explains. “A certain number of these become a painful neuroma, like a ball of scar tissue at the end of a nerve. If a patient touches or hits that nerve, it causes pain—sometimes severe pain.”
Several surgical techniques can be used to treat a neuroma, including scaffolding, nerve repair, and nerve transfer.
“One of my patients severed a digital nerve (a nerve in one finger) and developed nerve pain after the cut healed. With minimal incisions on the finger, I found both ends of the severed nerve, cut away the scar tissue, and used nerve scaffolding with graft tissue. Sewing the graft to the ends of the damaged nerve allows the nerve to regrow into the scaffolding. Over time, if they grow together, the pain could be reduced or stop all together.”
If both ends of a nerve are available and long enough, the ends can be simply stitched together, or repaired, without using a graft. If this isn’t an option, a nerve transfer might work.
“As a hand surgeon, I see people with lacerations. It’s pretty common to see patients who, for instance, accidentally slice open the palm of their hand while holding and cutting fruit, like an avocado. They don’t just cut skin and muscle, they sever nerves,” explains Dr. Woodall.
“Deep lacerations could sever the ulnar or median nerve, causing loss of feeling in the fingers or power to the thumb. If the injury doesn’t heal properly, then surgery can help restore feeling and movement to the fingers and thumb.
“For instance, to restore thumb opposition—the ability of the thumb to touch the other fingers—I can transfer a section of the ulnar nerve to the median nerve.”
Dr. Woodall is also able to perform nerve and tendon transfers in the upper arm, which can restore the arm’s ability to flex at the elbow, and in the forearm, to restore wrist, finger, and thumb functions.
Treating more complex nerve injuries
In more complex injuries, such as when a hand has been mangled, painful nerves can be treated with specialized reconstructive microsurgery. Dr. Woodall explains one such procedure:
“To cap the nerve with muscle tissue, a small piece of muscle from near the injury location, perhaps a one-inch strip, is separated from the body and denervated. The strip is wrapped around the end of the damaged nerve, which can sprout new nerve endings into the strip of muscle. This is called regenerative nerve interface. The muscle and nerve are placed into another muscle and blood supply is reestablished. This technique helps reduce pain in most patients.”
Outcomes vary, but surgery is worth the risks
Regardless of the type of surgery used to treat nerve injuries, outcomes vary drastically.
“When you sew a blood vessel together, you get flow back immediately, like with a repaired pipe. But a nerve it is like a tree root. It takes time for nerves to grow back, to grow together,” says Dr. Woodall. “I’m always upfront with my patients about this. They may not notice any change for six months or more. Even then, the result may not be what they had hoped for. If a patient had little or no mobility in their hand, for instance, then even minor improvement can make a big difference.”
Outcomes for patients with nerve pain are equally unpredictable. Surgery for nerve decompression can result in fairly fast pain relief, as with surgery for carpal tunnel syndrome. Surgery for neuromas, however, may never completely take pain away.
But, as Dr. Woodall says, “Even minor improvements can mean a lot. A great outcome may be less pain for someone who has really bad pain. The risks [of surgery] are low and the possible benefit is high, so it really is worth exploring.”