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Rare transplant aims to 'rewire' nerves

Mother donates tissue to restore sensation in son's hand

By Michael Smith
MedPageToday Staff Writer
"I fought very hard not to let them amputate his arm," Frankie Anderson-Harris said of her son Nick.



Transplant surgery
Auto accidents

BALTIMORE, Maryland (MedPageToday) -- It was three days before Christmas last year. Nick Anderson, a budding race car driver, was on his way home from a friend's house.

"My car spun out and hit the guardrail," recalls Anderson, now 19. The guardrail slammed through the vehicle, ripping off his left leg at the knee, shattering his right leg and destroying his left elbow, leaving his left hand paralyzed.

On Thursday, a surgical team at Johns Hopkins University School of Medicine is trying to repair some of that damage by performing a rare operation -- a mother-to-son nerve transplant with the goal of restoring sensation and function to Anderson's paralyzed hand.

If it succeeds, it will be a triumph both of will and of science.

"I fought very hard not to let them amputate his arm," says Anderson's mother, Frankie Anderson-Harris, 40. "I didn't want to see him lose the arm because I thought technology and science would catch up to him."

And, she said on the eve of the surgery, "it kind of has."

To restore Anderson's hand, surgeon Dr. Allan Belzberg of Johns Hopkins will have to replace two of the three main nerves in the lower part of his left arm -- nerves that were torn out in the accident.

"They're gone," Belzberg said. "There's a huge gap where the nerves should be."

Combined with the extensive damage to Anderson's legs, that gap -- about 7 inches of missing tissue -- meant Belzberg couldn't harvest the needed nerve tissue from elsewhere in the young man's body.

Family members volunteered to donate nerves, and Anderson-Harris' tissue was found to be a close match to her son's.

"Sometimes you feel very, very helpless, and it's nice to be able to do something," she said. "I was glad to be able to do it."

Anderson-Harris underwent surgery to both legs and arms last week, so that Belzberg could get the tissue he needs.

"Mom's a bit sore right now," Anderson said.

For Anderson-Harris, losing the nerve tissue will mean some numb spots on her feet and on the insides of her elbows. Those numb spots will grow smaller over time, Belzberg said, but will never disappear entirely.

Today, Anderson-Harris says, "I can walk -- I don't walk well yet -- but I can walk. And unless you see the staples in my arms, you can't tell anything happened."

Only a handful of such transplants have been performed, Belzberg said, and the state of the art is evolving rapidly. Even in the past couple of years, he said, "we've made some very good advances in rewiring nerves."

In Anderson's case, the idea of the surgery is simple -- the severed ends of his medial and ulnar nerves will be joined using the nerve tissue from his mother. Over the next few months -- if the grafts are not rejected -- his body slowly will replace his mother's cells with new ones of his own.

Until then, he'll have to take drugs to suppress his immune system, just like any other transplant.

Belzberg said he'll know within a few months if the graft has taken, and the first signs of restored function will come in about a year, if all goes well.

But the chances for successful nerve repair are greater the earlier it's done, Bezberg said, and Anderson-Harris was "100 percent right" to refuse to let doctors amputate her son's arm.

"In a lot of these patients, I can repair the nerves and save the limb," he said, but other doctors aren't aware of the advances that have been made.

"For whatever reason, it's just not out there in the medical community," he said. "We need to get the word out there -- don't go lopping things off until you check with us."

On the other hand, he noted, there is a bottleneck because only a handful of doctors can perform such nerve surgery.

"The whole field of nerve repair has taken off -- there're just not enough of us doing it," he said.

For Anderson, the past year has been a long road and, the night before his surgery, he was trying not to get too high or too low. "I want it to work, but if it doesn't, I don't want to get too bummed out about it," he said.

He doesn't remember his mother's battle to prevent amputation -- he was in a coma at the time. But he remembers the battle to find new options after he woke up.

"I've had four or five opinions, and they were all different from one another," he said.

Eventually, he said, researching the options led to Belzberg and this week's operation.

Anderson's advice? Do your homework, find the best choice, and "once you decide it's a good idea, go for it."

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