Prognosis for recovery

[nigel]

Dear Surgeon/readers

I am trying to obtain as much information as is possible
regarding the prognosis for an injury our youngest son (Dean aged
16) sustained last week Thursday (23 Oct). In a nut shell, Dean's left hand went through a glass window at school and the resulting damage was attended to in theater some 7 hours later (not counting the paramedic stabilisation etc.).

He was in theater for over four hours (includes 'recovery') and had
seven tendons, one artery and the main nerve (Radial) + a few 'branches'
(?) sown back together. The surgeon has discussed our sons injury and commented on how serious the damage was. In fact the lacerations were so severe that Dean is very lucky to still have his hand attached. Apparently one good point is that the cuts were 'clean' and not 'ripped'. The Surgeon was very open and advised that we should only expect a 50% recovery regarding 'normal' functionality. The main concern being the ability of the nerve (radial?) to re-establish its 'connections'. The ability to use an 'opposing thumb' plus fine motor controls being the area's most likely to be affected.

Dean is a very practical lad and until now has made much use of his 'engineering/practical' abilities to fix mountain bikes, construct models and other activities such as pioneering with the scouts.

I am not wanting to find someone to give us the answer "all will be ok in time, expect a 100% recovery" (although if there is evidence to suggest that this is possible then GREAT!) but I am looking for more insight into the physiology of nerve repair (apparantly new growth from the spine (or does re-growth start from somewhere else?) will take place at 2mm per day but only after the existing nerve has died (10 days?)) and what to expect  regarding recovery and if anything (in addition to positive attitude) can be done to promote a full  recovery. e.g. Homeopathy?

With many thanks in advance and looking forward to whatever information you can pass along together with any other pointers of where we as a family can find out more.

Very best regards from sunny South Africa

Nigel Rotherham and family

e-mail to nigel.***@****

[CCF Neuro[P] MD, RPS]

Dear Nigel:

Wonderful news!  We actually need to have good news for our own peace of mind and stability of emotions.  Neurological disorders can be really taxing.  I am so happy for you and your family.  Keep us informed.

Sincerely,

CCF Neuro MD

[nigel]

The following is a comment made by the specialist to the physiotherapist concerning the progress made by Dean..." It pays to go to church"...!! And the reason? Well, according to the surgeon, if he had not performed the procedure he would not have believed the damage actually occurred based on the recovery observed to date!  Dean still has a LONG way to go including more surgery as there is much tethering of the seven tendons which has limited movement and as yet there is limited control of thumb etc. and nerve regrowth is nothing short of miraculous.

We will keep you posted as progress is made.

All the very best from Nigel R and family in sunny South Africa

[CCF Neuro[P] MD, RPS]

thanks.

CCF Neuro MD

[nigel]

Dear surgeon / readers

As promised, an update following our visit to the hospital Friday 1st October. Dean had his cast / dressing opened for the removal of about 70% of the external stitching (approx. 45 sutures) leaving those across the palm intact until another time. There is an area of about 1.5 square inches where there is no skin and this apparently must be kept under close observation as blood supply to the area is also damaged... That was the good news. It would seem that when the specifics of the trauma were explained (day following surgery) I misunderstood the surgeons remarks as the reality of the situation (think I'm one of those parents who is finding it more difficult to accept than the patient...) is that Dean's Radial nerve was the LEAST damaged. Both the Median and Ulnar nerves were severed (along with tendons etc.) which is why the chance of recovery has been given at 50% The surgeon who
performed the operation explained in detail during Fridays visit the reconstructive surgery he performed adding that although he aligned the ends of the severed nerves as close to what seemed to be correct, there is no way of ensuring that all the individual 'connections' will eventual align with their originals. He did comment that having surgery relatively soon (7 hrs) after the incident was a plus point as this will have lessened the chance of scar tissue forming and hence blocking the path of nerve re-growth. Hence the 50/50 (optimistic) prognosis...

Dean's next appointment is for this coming Wednesday (Oct 6th) when a physiotherapist specialising in hand trauma will start the rehabilitation process which must be performed until such time
(estimate is at least 12 months) that nerve growth / recovery is such that Dean will be able to manipulate his own wrist/hand within whatever limitations prevail.

Thank you again for providing a forum for the exchange of comment / advice. Knowing that there are many others around the world who are undergoing treatment for a variety of conditions and / or seeking information plus being able to receive words of encouragement from concerned families and individuals is VERY comforting.

If the invitation to report on Dean's progress is still valid then I will post again when there is more news. Until then, KEEP SMILING :)

Nigel R and family in sunny South Africa

[CCF Neuro[P] MD, RPS]

Hope that all will be fine.

CCF Neuro MD

[Nigel R]

Thanks for the continued interest.  Will post an update after visit to specialist this coming Friday (Oct 1st).

To you and everyone involved in making this service possible(inc concerned readers who have replied directly), THANK YOU :-)

All the very best from the Rotherham family in South Africa

[CCF Neuro[P] MD, RPS]

Let us know how he does.

CCF Neuro MD

[nigel]

Dear respondent and readers.

Many thanks for the very prompt reply, MUCH appreciated:-)

We believe that the human body is quite capable of amazing recovery and your response (from a medical perspective)is reassuring even if there is still a great deal yet to learn regarding how we work.

God has a reason for everything and with His help we can, AND WILL achieve miracles!

Sorry about getting the date mixed up (did you notice?):-( My mind must have been somewhere else when I posted our request for
information etc! Date of incident should have been Thursday 16th September.

Thanks again

Very best regards

The Rotherham family in South Africa

[CCF Neuro[P] MD, RPS]

Dear Nigel:

Sorry to hear about your son.  Since the transection was very close to the hand, a clean cut, and surgery reconstruction realitively soon after the trauma, I think your son has a better than average chance of having recovery of his radial nerve.  I don't think that predictions are readily possible (i.e. 30% or 80%).  Since the regeneration only has to occur over a few centimeters there is more of a possibility that correct reinnervation of nerve to muscle groups will occur.  The radial nerve really does not mediate the opposition of the thumb, that is a median nerve function.  The radial nerve abducts the thumb or allows the thumb to move away from the index finger.  We are only beginning to understand the interplay with muscle growth factors and nerve regeneration in the peripheral system.  There is no know evidence that homeopathy would have any effect on this process.  We know that the peripheral nerve will regenerate from the site of the lesion to the distal or furtherist point.  Things that block this growth will affect the process adversely.  What these things might be would be collagen growth, immunological reactions to induce collagen growth and fibrous growth.  But how much to control the immune system is unknown.  All I can really tell you is that I think that there is a better than average chance for good recovery, only God and the healing process to eventually tell what that is.

Sorry I can be more helpful.

Sincerely,

CCF Neuro MD