Pioneering surgery: Neurosurgeons redirect nerves from foot to enable thumb movement in patient's hand
Key Takeaways
A 55-year-old man in Italy was involved in a moped accident on his way to work, resulting in partial leg amputation and the loss of his hands. Surgeons at Turin City Hospital (CTO) transferred parts of the patient’s sciatic nerves from his amputated left foot to his brachial plexus.
The goal of the surgery is to restore mobility to the patient’s one hand. The surgery is rooted in the idea of neuroplasticity—the central nervous system’s capacity to adapt to external or internal stimuli.
Experts believe that this surgery will be successful; however, it may take some time for the patient to recover the use of his hand.
Surgeons at Turin City Hospital (CTO) in Turin, Italy, pioneered a nerve transfer surgery at the end of last year that, if successful, could help a patient regain the use of an immobile hand. 55-year-old Marcello Gaviglio was severely injured in a moped accident last year, resulting in the partial amputation of one of his legs as well as the loss of mobility in both of his hands, according to Reuters.[]
In an effort to reestablish use of one of the patient’s injured hands, surgeons at CTO transferred parts of Gaviglio’s sciatic nerves from his amputated left foot to his brachial plexus, a network of nerves that transmits signals from the spinal cord to the shoulder, arm, and hands.[]
This surgery is the first in which a nerve that controls the foot has been redirected to the hand. “It's the first time that someone transfers a component of the sciatic nerve to the brachial plexus,” Paolo Titolo, one of the surgeons who operated on Gaviglio, told Reuters on Wednesday. “[I]f it works it means that the brain plasticity can control other parts of the body that we didn't expect and also opens new fields in neuro studies,” he said.
According to the Journal of Neurosurgical Sciences, “Neuroplasticity is the capacity of the central nervous system to adapt to external or internal stimuli. It is being increasingly recognized as an important factor which contributes to the successful outcome of nerve transfers…The potential for plastic adaptation should be taken into consideration if the surgical strategy and postoperative rehabilitation are planned, as its influence on results cannot be denied.”[]
The medical team is hopeful that the surgery will restore mobility to the patient’s hand, but it could take time. Gaviglio will need around five months of post-operative care in order to train his brain to make new connections between the nerves and the hand.
W. Lee Warren, MD, FACS, an author and neurosurgeon at Great Plains Health Brain & Spine in North Platte, NE, says, “The brain has the ability to create new connections and learn new things. We used to think we were stuck with the brain we had. We know now that we make new brain cells each day and that we can make new patterns, behaviors, and movements.” He says he’s very hopeful that Gaviglio’s surgery will prove a success.
But how does it work? Dr. Warren says that the medical team will have the patient use neurofeedback, the act of thinking about his hand while telling his foot to move. For example, when the patient thinks of his big toe, he will be able to control his thumb.
“Over time, that will fire the muscle. And when he sees [the movement] with his eyes, he'll teach his brain a new synapse,” Dr. Warren explains. One day, the patient won’t have to continue making that specific connection anymore. “That will happen over time in his brain. People can retrain their brains,” he adds.
“The technical parts of his surgery are built on generations of other surgeries and microsurgery,” Dr. Warren says, also emphasizing the controversial research done on Silver Spring monkeys, in which the monkeys could not feel their arms but were still able to move them. This is what set the stage for the basis of neuroplasticity, Dr. Warren explains.[]
Brian J. McHugh, MD, a board-certified neurosurgeon, says that surgeries like these offer hope to patients, as “physicians and surgeons have gotten better and better at transplanting and reconnecting peripheral nerves, specifically with grafts from other parts of the body.”
Nerve transfer surgeries still have limits, though, he says. When it comes to spinal cord injuries, for example, science hasn’t yet mastered conduct grafting, Dr. McHugh says.
“The big difference is that the peripheral nerves are part of the peripheral nervous system, whereas the spinal cord is part of the central nervous system,” Dr. McHugh says. “The central nervous system is more complicated, and thus more difficult to repair and heal from injuries with recovery of function. The peripheral nervous system is more anatomically simple.”