The good and bad of my doctors appointment
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Chillywil91
- Posts: 17
- Joined: Tue Feb 10, 2009 2:25 pm
The good and bad of my doctors appointment
So earlier this week I met with the top Neurosurgeon at the University of Michigan. From my appointment I learned some good and bad news. The good news for those newly injured: The Avance product from Axogen Inc can lessen the effects of brachial plexus injuries if not nearly correct it altogether. This is as long as denervation atrophy has not set in. If it has (as in the case of my upper shoulder and bicept) the solution is a series of free muscle transfers. So can the advances in repairing nerve injuries help us? Yes, as long as there is still muscle to reinnervate. If atrophy has set in, we have to wait until they develope a way to regrow muscle lost to denervation or transfer muscles from other parts of our body. If anyone knows of other solutions please let me know. I hate the very idea of a free musce transfer to fix my bicept, but it may be the only option other than wait and pray.
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Christopher
- Posts: 845
- Joined: Wed Jun 18, 2003 10:09 pm
- Injury Description, Date, extent, surgical intervention etc: Date of Injury: 12/15/02
Level of Injury:
-dominant side C5, C6, & C7 avulsed. C8 & T1 stretched & crushed
BPI Related Surgeries:
-2 Intercostal nerves grafted to Biceps muscle,
-Free-Gracilis muscle transfer to Biceps Region innervated with 2 Intercostal nerves grafts.
-2 Sural nerves harvested from both Calves for nerve grafting.
-Partial Ulnar nerve grafted to Long Triceps.
-Uninjured C7 Hemi-Contralateral cross-over to Deltoid muscle.
-Wrist flexor tendon transfer to middle, ring, & pinky finger extensors.
Surgical medical facility:
Brachial Plexus Clinic at The Mayo Clinic, Rochester MN
(all surgeries successful)
"Do what you can, with what you have, where you are."
~Theodore Roosevelt - Location: Los Angeles, California USA
Re: The good and bad of my doctors appointment
Chillywil91,
I think your doc may have misled you. While Axogen's product will be a great advance for peripheral nerve injuries, it won't solve the problem of nerve avulsion (peripheral nerve being torn out of the spinal cord). While a damaged peripheral nerve can be repaired & has the ability regenerate fairly well if it's injured distally from the spinal cord (and Axogen's artificial nerve is intended to replace the damaged segment), as soon as a nerve's roots are avulsed from the cord the issue becomes completely different. It's the same as a spinal cord injury. A whole process happens where proteins are released that inhibit nerve regeneration and a type of scar barrier is created the blocks any regeneration.
People with spinal cord injuries, where the peripheral nerve's pathway have never been damaged or disconnected (like an avulsion) have been able to have atrophied muscles function again years and years after initial injury. The real issue is having a nerve connection completely separated and the Muscle Plate (the junction where nerve actually connects to the muscle) becoming fibrous, and after two years neural impulses can no longer pass to the muscle. It is my understanding that researchers are creating few possible remedies for this.
I've had a free muscle transfer from my thigh to my biceps region and it works pretty well. I can't lift more that 4-5 pounds with it, but it helps me flex my elbow. I see it as a temporary fix until a real cure comes around. I don't notice any difference in the leg surprisingly, and it's been 7 years coming up since I had the surgery in April 2003 at the Mayo Clinic.
I'll try and repost some research I'd read a while back about the major issues needed to be solved for BPI repair.
Best of luck with you decision on your muscle transfer.
Christopher
I think your doc may have misled you. While Axogen's product will be a great advance for peripheral nerve injuries, it won't solve the problem of nerve avulsion (peripheral nerve being torn out of the spinal cord). While a damaged peripheral nerve can be repaired & has the ability regenerate fairly well if it's injured distally from the spinal cord (and Axogen's artificial nerve is intended to replace the damaged segment), as soon as a nerve's roots are avulsed from the cord the issue becomes completely different. It's the same as a spinal cord injury. A whole process happens where proteins are released that inhibit nerve regeneration and a type of scar barrier is created the blocks any regeneration.
People with spinal cord injuries, where the peripheral nerve's pathway have never been damaged or disconnected (like an avulsion) have been able to have atrophied muscles function again years and years after initial injury. The real issue is having a nerve connection completely separated and the Muscle Plate (the junction where nerve actually connects to the muscle) becoming fibrous, and after two years neural impulses can no longer pass to the muscle. It is my understanding that researchers are creating few possible remedies for this.
I've had a free muscle transfer from my thigh to my biceps region and it works pretty well. I can't lift more that 4-5 pounds with it, but it helps me flex my elbow. I see it as a temporary fix until a real cure comes around. I don't notice any difference in the leg surprisingly, and it's been 7 years coming up since I had the surgery in April 2003 at the Mayo Clinic.
I'll try and repost some research I'd read a while back about the major issues needed to be solved for BPI repair.
Best of luck with you decision on your muscle transfer.
Christopher
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Chillywil91
- Posts: 17
- Joined: Tue Feb 10, 2009 2:25 pm
Re: The good and bad of my doctors appointment
Thanks Chris,
My bracial plexus injury wasn't an avulsion. My clavicle was broken (amoung a lot of other things) in a car accident. The nerve injury occured near the break and only effected the upper shoulder and bicep muscle. Doesn't change the fact that I still need the transfer done. I'm glad to hear your procedure was successful. Makes me feel a bit more confident to get it done.
My bracial plexus injury wasn't an avulsion. My clavicle was broken (amoung a lot of other things) in a car accident. The nerve injury occured near the break and only effected the upper shoulder and bicep muscle. Doesn't change the fact that I still need the transfer done. I'm glad to hear your procedure was successful. Makes me feel a bit more confident to get it done.
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Christopher
- Posts: 845
- Joined: Wed Jun 18, 2003 10:09 pm
- Injury Description, Date, extent, surgical intervention etc: Date of Injury: 12/15/02
Level of Injury:
-dominant side C5, C6, & C7 avulsed. C8 & T1 stretched & crushed
BPI Related Surgeries:
-2 Intercostal nerves grafted to Biceps muscle,
-Free-Gracilis muscle transfer to Biceps Region innervated with 2 Intercostal nerves grafts.
-2 Sural nerves harvested from both Calves for nerve grafting.
-Partial Ulnar nerve grafted to Long Triceps.
-Uninjured C7 Hemi-Contralateral cross-over to Deltoid muscle.
-Wrist flexor tendon transfer to middle, ring, & pinky finger extensors.
Surgical medical facility:
Brachial Plexus Clinic at The Mayo Clinic, Rochester MN
(all surgeries successful)
"Do what you can, with what you have, where you are."
~Theodore Roosevelt - Location: Los Angeles, California USA
Re: The good and bad of my doctors appointment
I can't suggest strongly enough to visit the BPI team at the Mayo. I interviewed the best surgeons that I could find here in the States and in the UK too. They will spell out all the possible options you've got based on the latest techniques being practiced in the US. They have initiated surgical techniques to be put into practice here in the states that where being done elsewhere for years.
I know it's hard to take, but your extremely lucky to have no avulsions. The possibilities for some kind of functional recovery are so much greater if your nerve roots are intact.
When was the date of your injury if you don't mind me asking? I think I read about a year & a half ago?
I know it's hard to take, but your extremely lucky to have no avulsions. The possibilities for some kind of functional recovery are so much greater if your nerve roots are intact.
When was the date of your injury if you don't mind me asking? I think I read about a year & a half ago?
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Chillywil91
- Posts: 17
- Joined: Tue Feb 10, 2009 2:25 pm
Re: The good and bad of my doctors appointment
I was injured 10-17-07. A delivery van crossed the median, got airborn, and landed on the car I was driving. It was a known possibility that I might have a brachial plexus injury due to the clavicle break. But I was so unstable, and there were so many other things wrong, it wasn't confirmed until my shoulder started to atrophy. Anyways, I'll follow your advice and contact Mayo. A second opinion would be nice. In the mean time I'll post info on any new studies I come across on the research forum.