Hopkins doctors perform rare nerve transplant

With mother's tissue, New Jersey man hopes to regain use of hand

November 18, 2005|By JONATHAN BOR | JONATHAN BOR,SUN REPORTER

It has been 11 months since Nicolas Anderson crashed his car into a New Jersey guardrail that severed one leg, crushed the other and left his left hand dangling without feeling or motion.

Yesterday, in an exotic, six-hour operation at Johns Hopkins Hospital, surgeons hoped to turn his hand into a useful instrument again - by grafting nerves from his mother's arms and legs into his damaged left arm.

Neurosurgeon Allan J. Belzberg said the operation went well, though it will take several months for the nerves to grow and connect to muscles in the hand. Only then will anyone know whether the transplant was a success.

"My hope is that my arm will come back enough to grasp at the steering wheel so I can drive my car," Anderson, 19, of Acton, N.J., said the day before the operation. He said he cared less about operating an ordinary vehicle than the race car that he drives around a dirt track at 160 mph.

For many years, surgeons have repaired injured limbs by relocating nerves from one part of a patient's body to another. But in an era when heart, lung and kidney transplants are commonplace, surgeons are less accustomed to transplanting nerves from one person to another.

Hopkins has joined a tiny group of hospitals that attempt nerve transplants, which doctors see as a last-ditch alternative when a patient needs more nerve fiber than he can possibly borrow from other sections of his body.

So far, surgeons have relied mainly on cadavers to supply nerves for transplant.

But last week, Belzberg "harvested" more than four feet of nerve - resembling limp spaghetti - from the arms and legs of Anderson's 40-year-old mother, Frankie Anderson Harris. The nerves were refrigerated until yesterday.

In that operation, the surgeon took sensory nerves - those supplying feelings of touch, hot and cold - so Anderson's mother wouldn't lose any function in her arms and legs. Although she's dealing with the expected post-surgical pain, she said the operation left her with only a few numb spots.

Yesterday, Belzberg began the delicate microsurgery on her son by opening a nine-inch section of his left arm that straddled the elbow.

About midway into the operation, Belzberg used tweezers to lift four strands of donor nerve from a moistened towel and placed them lengthwise into the splayed arm.

"Stay there," he said under his breath as he peered through a microscope and prepared to stitch them in place. "Stay there and don't move."

Not far away, Anderson's family waited. The entourage consisted of the young man's grandparents, Patricia and Frank Anderson; his father, Jim Harris; and his mother - who sat in a cushioned chair, resting outstretched legs on the seat of the wheelchair she has been using since last week's operation.

"The hardest part is the wait," she said - and not just yesterday's long operation, but the months ahead. "It's not like an organ transplant when you watch and know right away if it works."

Nick Anderson's saga began in December when he lost control of his car while returning from a friend's house. The vehicle struck the end of a guardrail, which pierced the car and shattered his legs.

The rail also took out a large section of his left arm, destroying his elbow and two of the three nerves that trigger the muscles in his hand. Anderson might someday receive an elbow transplant, but for now doctors are concentrating on restoring the use of his hand.

Without use of his hand, Anderson has trouble with simple tasks such as eating, dressing and playing cards. He has made some remarkable adjustments, however: He can work dual video-game joysticks by holding one and sticking the other in his mouth.

In New Jersey, the family said, four different doctors recommended amputating the injured arm. That way, he could learn to use a prosthesis, just as he has learned to walk on artificial leg.

But Anderson rejected the notion, saying he would try just about anything to keep his hand. Foremost in his mind was being able to drive his race car, impossible with even the most advanced prosthetics. His vehicle - a so-called big-block modified - requires one hand to operate a hand clutch and the other to grip the wheel.

The family searched for alternatives and eventually contacted Belzberg at the suggestion of another Hopkins neurosurgeon, Benjamin Carson.

How they got to know Carson, a world-famous surgeon and author, is another story. Three years ago, Carson successfully removed a brain tumor that was causing Anderson lightning-quick blackouts.

In recent years, Belzberg has become a maverick in the world of nerve restoration surgery, not only grafting nerves from one part of the body to another but also rerouting nerves to serve new functions.

Three weeks ago, he operated on Anderson for the first time, thinking he could fix the young man's hand with grafts borrowed from his leg. But he was surprised and disappointed when the damage proved too extensive.

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