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Sunday, February 21, 2016

Steadying the Nerves

Posted By: Advancing Care

Thanks to new technology, a Hudson Valley man who suffered a severe injury and nerve damage is on the road to recovery.

By Mary McIver Puthawala, RN, BSN

Life can change in an instant. For Jose Ponce, that instant was when his arm got caught in a wood grinder at work. After a call to 911, emergency personnel determined that the severity of his injuries required the expertise of a trauma center. Ponce was flown to Westchester Medical Center, the flagship of the Westchester Medical Center Health Network, to save his life and, hopefully, his arm.

Once in the operating room, doctors determined that not only had the accident severed the artery in Ponce’s arm, a large portion of the nerve was missing. In the critical hours that followed, doctors were able to graft an artery, restoring blood flow. However, Ponce had no muscle control or sensation in his limb. due to the loss of a nerve that was alongside the artery, His life and arm would be saved, but could anything be done to restore the usefulness of his hand?

This is a situation that Francis Winski,  MD, a board certified plastic surgeon at Westchester Medical Center, has seen a lot. In the past, when a nerve was missing, surgeons had to transplant new nerves to the affected area, taking them from another part of the body. The results of that procedure were mixed. “We used to have to harvest superficial nerves, but then [the patient] ended up with numbness in those areas of their bodies – sometimes in a foot, sometimes in the arm,” said Dr. Winski.

Fortunately, Ponce was able to benefit from new technology that uses donated nerve tissue to form a “channel” inserted in place of the damaged nerves, allowing them to grow. Imagine a handful of insulated wires bundled together and then cut. Once the wires are removed, all that’s left is the insulation with empty tubes – or “channels” – where the wires used to be. In nerve cells, this natural “insulation” is called myelin. In a nerve graft, the donated myelin is specially treated so it can be transplanted into the patient without the risk of the body rejecting it. Surgeons are able to sew the graft in place, bridging the neural gap between the spine and the extremity.

Once the myelin is in place, the injured nerve will grow inside the graft all the way to the limb, ideally restoring function and sensation. Dr. Winski expects this process to become more common for those suffering nerve loss. He advises anyone diagnosed with nerve loss to be evaluated for the possibility of nerve-graft surgery as soon as possible after the trauma.

Since nerves grow slowly, the road to recovery takes time to navigate. Ponce had his nerve graft done in August, 2014. Since his surgery, he has been in physical therapy to preserve the function in his wrist and fingers. Dr. Winski explains that without steady therapy, joints will get tight and stiff. If this happens, by the time the nerves finish growing inside the graft to the hand, the hand will no longer be able to function. Today, Dr. Winski is seeing consistent signs of improvement in his patient. Ponce’s physical therapy will continue until he recovers as much typical function as possible.

“I hope one day soon to be fully able to move my hand and fingers, so I can go back to work,” Ponce says.  “Until then, I thank Dr. Winski for helping get my life back to normal.” •

For more information, call Westchester Medical Center Advanced Physician Services at 914-592-2400.

Photo By Bridget Herlihy