A terrible industrial accident nearly cost one man his hand. But two doctors with Center for Orthopaedics in Lake Charles used a nerve, bones and skin from other parts of his body to reconstruct the man's hand and give it sensation again.
Hand surgeon, Dr. Andrew Foret, and foot and ankle specialist, Dr. Tyson Green, typically work on different patients with a different set of medical needs. But the two recently paired up for an innovative surgery that saved a man's hand and its sensation. "The patient had an injury that essentially went all the way through the entire hand and it was at the base of his middle and index fingers," said Dr. Foret.
The bones, tendons, tissue and nerves of the hand were damaged - a traumatic injury that is equivalent to a gunshot wound straight through the hand. "Segments of bone were missing around the index finger metacarpal and the middle finger metacarpal," said Dr. Foret.
Repairing this patient's hand would require going into other parts of the body. A nerve was taken from the foot, bone from the hip, a tendon from the forearm and skin from the upper arm and thigh. It is a procedure that took some explaining to the patient. "You just explain to them, 'We're just going to take a piece of small bone from another area to reconstruct the hand to try to make it similar to the way it was before. Same with the nerve graft, we're sacrificing a nerve in one part of the body to allow sensation in the hand,'" said Dr. Foret.
One of those sensation nerves that could be transplanted in another part of the body is the sural nerve. It runs on the outside of the foot and heel. "You've got to look at which one is the more important," said Dr. Green, "sensation to the outside of the foot or sensation to your hands for grasping and working."
For this patient, using the hand again was most important, so the harvesting plan got underway. "A nerve harvest is basically dissecting the nerve free from all of the surrounding tissue and cutting it out in the certain segment that's needed for transfer," said Dr. Green.
Through three small poke holes, 12 centimeters were cut off the nerve, along with three segments, then put into the hand. "The nerve is actually sewn directly into the nerves that are in place with a microscope and very fine sutures that are probably about the size of a human hair," said Dr. Foret.
The nerve regenerates through the nerve tissue and will begin to bring back function and mobility. It an outcome that saved a hand and the chance to work with it again.
To recreate the structures within the hand and finally perform the foot-to-hand nerve graft, it took a total of four surgeries. The patient is now in physical rehab and slowly regaining feeling in his hand.