Nerve Transplants: A Little-Known Alternative to Amputation

By Lana Christian

Although nerve transplants have been performed since the late 1980s, the surgery is still a well-kept secret. Because of that, the general public doesn’t know to ask for it. But it could be a viable alternative to amputation.

When you hear the word "transplant," the mental image conjured is usually that of a heart or kidney transplant. Put it in; sew it up; give the person immunosuppressive drugs for life … and, if all goes well, everything functions as it should. Nerve transplants work very differently.

Nerves don’t function on their own when they’re transplanted. Instead, they serve as a framework or "guide wire" onto which the patient’s own nerve cells eventually grow. The physician has to set up connections so that new nerves can grow along the right pathways. But that growth doesn’t happen quickly. Nerves grow about an inch a month. So patients need to expect a long rehabilitation — up to two years, depending on which nerves were severed due to injury. So, if the site for a nerve transplant is the forearm, a person’s recovery may proceed like this: first, regain feeling in fingertips; regain the ability to distinguish hot and cold in various places on the arm; regain hand dexterity; and last, regain ability to bend/move/use the entire forearm.

Nerve transplants offer many advantages over amputation. The most obvious benefit is the aesthetic aspect. In addition, if healthy nerves can be grafted from other sites on the patient (called an autograft), no immunosuppressive drugs are needed. If a patient needs to have nerves donated, immunosuppressive drugs are given only until the patient’s nerves grow back.

As with anything, nerve transplants have some drawbacks. Timing is critical. The optimal time to do this is three months after the injury. People need to be able to find and consult with a specialist who can schedule this within that time frame. Another drawback is that you can’t know with certainty how much function will return. Reason why: The body is busy with many things after a nerve transplant. Besides growing the nerves themselves, it is re-establishing pathways to and from the brain that tell the body what to do and how to do it (like bend the arm, and so on). The success of that "rewiring" depends on rehabilitation and sheer persistence as the body creates new pathways for carrying nerve signals.

Nerve transplants are being done on our soldiers in Iraq. Their protective gear leaves their arms and legs exposed (so they can maneuver and run) — which is creating what one officer calls "a war of the extremities." A soldier who suffers a blunt injury to an isolated spot of the nerve is a good candidate for this type of surgery. Closer to home, nerve transplantation made CNN headlines when a teenager was severely injured in a motorcycle accident. His injuries were too extensive for doctors to attempt autografts, so they tissue typed his family. His mother was the closest match. Her son received nerve transplants from both her legs and arms. Instead of losing an arm and a leg, today he has both. As he continues his rehabilitation, he is relearning to walk.

Supply and demand will drive the need for more physicians to be trained in this highly specialized surgical procedure. As Dr. Allen Belzberg of the Johns Hopkins University School of Medicine bluntly puts it, "We need to get the word out there — don’t go lopping things off until you check with us."