Thousands of Britons lose the use of a hand or limb after damaging nerves in accidents, but surgery to transfer muscle and nerves can restore movement.
Simon Harbinson, 24, a buyer for a beverage company from Guisborough, Yorkshire, tells CAROL DAVIS his story.
Simon Harbinson, 24, tells CAROL DAVIS his story
One morning in January 2013, when I was riding a motorbike from work, I made a turn, hit the curb, and landed on the road.
I was taken by an ambulance to James Cook Hospital in Middlesbrough and when I came home two days later, doctors told me that I had broken four discs in my neck, damaged my right shoulder, pierced a lung, broke my jaw, and a brain had bleeding. They put me in a full body brace while I healed.
But while the other injuries recovered, I still couldn't lift my right arm after four months.
The doctor said that I had damaged nerves in my shoulder and that I had no chance to regain movement or feeling, or my right arm, without further assistance.
I had a lot of physiotherapy and hydrotherapy, but the arm wouldn't do anything. It felt permanently numb and I could no longer ride my motorcycle, or even do basic things, such as cooking and cleaning for myself, or buttoning my coat.
So five months after the accident, I was referred to Leeds General Infirmary to see a specialist surgeon for tests and to discuss surgical options.
MRI scans showed that I had cut the nerves in the shoulder; the surgeon did a reconnaissance operation to try and fix them using the nerves I had on the back of my calf.
But although I could now feel my tricep in my upper arm, I still did not feel my lower right arm or shoulder (or bend my elbow). I was a food industry laboratory technician, had tasted and checked drinks, but because I was unable to bend and raise my arm, I couldn't do it anymore.
The company found an order for data entry and I worked my way up to the job of my current buyer, which is great because I was actually sitting at a computer. But it was frustrating not being able to do normal things, such as playing five-to-one with my brother.
I was only 19 and did not want my arm to live like that.
My surgeon explained that it was likely that the signals from the new nerve did not reach my shoulder muscle, but that she could try a rarely used procedure in which she would replace both the muscles and the attached nerves, rather than just the nerves.
I agreed and had the four-hour operation in March 2015 to remove the gracilis muscle and connected nerves, which helps move the leg.
This was then stitched into my arm. I woke up in a sling, which I had to wear for eight weeks while the arm healed.
I had a 30 cm wound in my inner leg and a 20 cm long wound that ran from my shoulder to just above my elbow. The leg pain bothered me, but morphine helped.
I agreed and had the four-hour operation in March 2015 to remove the gracilis muscle and connected nerves, helping to move the leg
When the sling was removed after eight weeks, I soon had physiotherapy and hydrotherapy – the heated water from the hydrotherapy pool kept my muscles warm, making it easier to train and this time I felt a slight muscle pull in my right arm – it was fantastic.
Although my arm was still incredibly weak, it turned out that the movement was coming back. I had physiotherapy and hydrotherapy for two years, and the movement gradually returned to my arm almost completely.
Now I can cook and do everything for myself, and while I cannot ride my motorcycle, I have learned to drive an automatic car. I started running while I was recovering, and now I'm back to shoot with my dad too.
I have also not noticed any change in my leg movements. The improvement was great.
Grainne Bourke is a consultant in hand and plastic surgery at Leeds Teaching Hospitals NHS Trust and Spire Leeds Hospital.
There are approximately 48,000 serious trauma cases annually, mostly as a result of traffic accidents, and about 1 percent of these patients have serious nerve injuries.
The nerve can be injured or broken and as a result, patients lose sensation and movement.
Often the people involved are active young men who feel that they cannot move their arm or leg, work or care for their family, and have a lot of pain, which is simply devastating.
Patients receive powerful painkillers, including morphine-based drugs, and are helped by a multidisciplinary team that can provide rehabilitation. And in some cases this alone will help.
There are approximately 48,000 serious trauma cases each year, mostly as a result of traffic accidents, and about 1% of these patients have serious nerve injuries (stock image)
Nerve and muscle transplants are another option and many more can benefit from this than is currently the case, but there is low awareness of this method, even among medical staff.
In some cases, nerve transplantation will only restore function, but in many cases the injury is too old – if the muscle does not get a signal from a working nerve over time, the connection between muscle and nerve may die, causing the muscle not to more can receive the signals it needs to move.
Once this happens, we need to add a new muscle with a working nerve that has already been confirmed. Therefore, patients should be referred to specialist centers early within a few weeks after death.
What are the risks & # 39; s?
- Standard surgical risks of bleeding and infection.
- Risk of bleeding problems, which affects up to 5 percent of patients.
- In some cases, the muscle does not work fully, so good strength is not restored.
& # 39; This is a great operation for patients who can no longer lift their hand or arm because it restores the function of the arm, and is a good option for patients with an arm or sometimes knee injuries that are fit enough for a operation of four to five hours, & quot; Dean Boyce, plastic surgeon consultant at Morriston Hospital in Swansea and Spire Cardiff Hospital.
We always use the gracilis muscle and an attached nerve that runs along the inside of the thigh while other muscles take over the task so that the patient has no leg weakness.
It can also be used for knee repair, although the leg needs more strength, so this is more difficult, therefore this technique is most often used for arm and shoulder repairs.
The use of a muscle from the patient's body means that there are no problems with rejection. We transplant it with nerves that cause the muscles to move in an operation that lasts four to six hours under general anesthesia.
In Simon's case, it was the brachial plexus nerves in the shoulder that had the right arm under control that was damaged.
I start by making an incision in the armpit, then I send electrical impulses through the nerves with the help of a nerve stimulator. This makes the nerves work, so we can see if we have targeted the right ones because the immobilized limb will vibrate.
I then make a 30 cm incision in the inside of the thigh to remove the gracilis muscle. We use diathermy (heat) that closes off the cut nerves while it cuts and closes the blood vessels to close them.
I move the transplanted muscle and attach myself to the coracoid bone, a small bone in the shoulder.
It is not necessary to remove the existing muscle because it has shrunk due to lack of use.
The other end of the muscle is attached to the tendon in the biceps in the upper arm.
Then I use a microscope to connect tiny blood vessels with sutures as fine as a hair, and attach the transplanted nerves to the damaged nerves in the arm and then I close everything up again.
Studies have shown good results for patients who have undergone a muscle transplant: two-thirds can bend their elbow well and 87 percent can do this while lifting a weight.
Many get their full function back, although some are permanently weaker. Although this technique will not help people with stroke paralysis or cerebral palsy, it can be given to many more trauma patients.
- The operation costs the NHS £ 13-15,000 and a comparable cost privately.