New cadaver nerve technique saves limbs from amputation
A promising new technique involving cadaver nerves is helping to rehabilitate limbs and save them from amputation, the Wall Street Journal reports.
More than 300,000 Americans annually suffer Injuries involving the peripheral nerves in their arms, legs, hands and feet. While combat is a major cause, car crashes and accidents with knives or other tools also produce similar injuries.
Previously, limbs injured in this way often could not be saved. If they could, it was usually through a type of nerve repair that would take a healthy nerve from another area on the patient's body, such as the back of the ankle. But the downside was that that area would then be forever numb.
The new technique is a different type of nerve graft. Called a nerve allograft, this technique uses pieces of cadaver nerves that are stripped of cells and other tissue to form hollow nerve channels. These can then be used to guide the growth of a patient's own nerve. The segments are made in different lengths and widths.
"We can take the exact size we need out of the freezer," Greg Buncke, director of the Buncke Clinic in San Francisco, a clinic that now uses allografts almost always in trauma cases, told the Journal.
Walter Reed National Military Medical Center has used the technique on more than 20 patients. "It has become the standard of care for our group," said Lt. Commander Patrick Basile, the center's director of microsurgery, told the Journal.
But, the Journal reports:
"Not all severed nerves can be repaired. Injuries to the central nervous system, in the brain and spinal cord, are almost always permanent."
But when peripheral nerves are damaged, a certain part of the nerve dies, leaving the sheath of the original nerve. The side of the nerve that still functions can grow back into the empty part of the sheath at the rate of a millimeter a day. The allografts are used in case there's a gap between the functioning part of the nerve and the dead part.
In addition to combat injuries and other accidents, the novel technique is being used in these ways:
- to repair nerves in oral surgery and cancer operations
- to reconnect erectile nerves damaged during prostate-cancer surgery
The allografts are made by AxoGen, which says that they have been used in about 7,000 patients so far. While most of those treatments were for nerves that control feeling, allografts are now being used in nerves that control movement as well.
Not all doctors have embraced allografts, mostly out of a belief that using a patient's own nerve is a proven technique. As of yet, there have been no randomized trials comparing the two types of grafts. However, several studies have shown that allografts offer results that compare well with autografts (grafts using a patient's own nerve).
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photo: The Emirr/Wikimedia