Frankie Davis was 10 years-old when he was in an ATV accident that ripped the skin, muscle and nerve off his arm – nearly to the bone. At the time, doctors were uncertain how much hand function he would regain. But two years later, he has made significant strides in recovery thanks to a new nerve replacement procedure.
“My niece was driving the ATV and saw a car coming at them,” said Frankie’s mother, Mary Davis. “The road wasn’t paved, and when she pulled over, the right wheel got caught in a gulley. She tried to pull out but the ATV flipped on the passenger’s side and [part of the vehicle] landed on his arm.
"The interior of his right arm was basically washed away,” Davis said.
Frankie was taken to O'Connor Hospital in Delhi, N.Y., where the doctors realized his injury was a level IV trauma – which they were unequipped to care for – and transferred him to Albany Medical Center.
At first, surgeons had difficulty assessing the extent of Frankie’s injury because the wound was so dirty from the dirt and gravel on the road, Davis said. Frankie’s initial surgery merely involved washing out the wound.
Once the area was cleaned, Frankie’s surgeon Dr. Jerome Chao, former chief of plastic surgery at Albany Medical College, noticed right away that part of the nerve in Frankie’s arm was gone – approximately 3.5 inches of it.
Without the nerve, Frankie had lost feeling and some function in his dominant hand, particularly in his ring and pinky finger.
Standard procedure for this type of nerve injury would be to graft nerve from elsewhere in the body – such as the leg or foot – to replace missing nerve in the arm. However, this procedure, known as nerve autograft, would have resulted in Frankie losing feeling in the location from where the nerve would have been taken.
“Autograft means you have to take the nerve from someplace else that…‘won’t be missed’ and move it to the place where you have to reconstruct the nerve,” explained plastic surgeon Dr. Darrell Brooks of The Buncke Clinic in San Francisco, CA. “You’re creating a deficit in one area to treat a deficit in another. You’re making a guess that the downside won’t be worse than the potential recovery.”
Brooks, who did not treat Frankie, added that the procedure also makes it necessary for two surgical sites on a person’s body – which increases the amount of time spent under anesthesia and the risk of potential complications.
An alternative method
But now, a relatively new procedure called nerve allograft is changing the way some doctors approach grievous nerve injuries like Frankie’s.
Nerve allograft is done by taking nerve from an unrelated donor – typically a cadaver – to replace the missing nerve in the person. The donor nerve is de-cellularized, meaning there is no risk of immune rejection.
The surgeon then implants the donor nerve into the place of injury, where it grows and reattaches to the other nerves in the body with the ultimate goal of restoring sensation and function. The procedure was introduced years ago, but has been slow to catch on among doctors due to a previous lack of literature and studies proving its effectiveness.
However, a recent multicenter clinical trial of nerve surgeries performed by Brooks and his colleagues at The Buncke Center indicates the results of nerve allograft are comparable in success to nerve autograft. Neither procedure fully guarantees restoration of feeling and function at the site of injury, but meaningful recovery is reported in 60 to 80 percent of patients in both surgeries. The results of the study were published in the journal Microsurgery.
In Frankie’s case, while some muscles near the site of the injury have not regenerated as his doctors had hoped, he has nevertheless made a significant recovery.
“He has fine manipulation and fine motor skills,” Chao said. “If he had not had reconstruction, there’s no way he could do what he can do now. I feel very strongly this was a success.”
Chao added that he would prefer to be treated with allograft over autograft if he suffered a similar injury.
“I wouldn’t want a separate surgical site – a deficit. I think the goal for all of us should be to use allograft 100 percent of the time if we can get the technology to that point,” he said.
Davis was similarly thrilled with the results of her son’s procedure.
“He’s a bright kid,” she said. “He glues together tiny Army figurines and paints them in camouflage. He even paints their eyes. It’s something that’d be hard for an adult to do, let alone someone who doesn’t have all the feeling in their arm.”