Lifewatch: Peripheral nerve surgery

Reported by Claire Hosmann - email
Posted by Debra Worley - email

WASHINGTON, D.C. (WECT) - A plastic surgeon at Georgetown University in Washington, D.C. has developed a procedure that helps patients who suffer from chronic nerve pain after surgery.

Thousands of patients every year experience pain for months or years after having a surgery or trauma.

Now, patients who are suffering more than 6 months after surgery have a new option that may eliminate their pain for good.

Harry Freedman is an avid cyclist, but for a few years, pain forced him to stop peddling.

"It was debilitating. It was hard for me to work. It was hard for me to sleep. You know, it's just hard to live," said Harry.

A bulldozer ran over him at work, severing his leg.

"The tires are five feet tall and he hit me with one of the tires," said Harry.

Harry lived in agony for a year.

"Let's say there's a storm and the telephone pole falls down and there's a live wire sparking on the road, that's what it feels like," said Harry.

Georgetown University plastic surgeon Ivica Ducic helped to ease his pain with a procedure he developed called peripheral nerve surgery.

"I'm after the source of the pain," said Dr. Ducic.

He removed the damaged part of the nerve and implanted it into the muscle, basically protecting the end of the nerve so it won't grow back and it won't cause any more pain.

The procedure is for anyone who's had surgery and who's also experienced pain for at least six months and drugs have failed.

After 17 surgeries and several different medications, peripheral nerve surgery was one of Harry's last options and it worked.

Dr. Ducic has performed this outpatient procedure 55 times over the last 18 months.  He says it has an 85-95% success rate.

For more information, please contact:
Georgetown University Hospital
Department of Plastic Surgery
(202) 444-8929

BACKGROUND: After surgery, disrupted nerves can leave a patient with excruciating pain, numbness and burning sensations caused by nerve compression or mechanical interruption. Patients often go through extensive examinations including X-rays and CT or MRI scans, which can be costly and may not specifically identify the nerve or nerves responsible for the pain. Amputees can experience this pain at the site where their amputation took place. This happens because the very bottom part of the nerves closest to the stump can get in to the scar tissue as it forms. This is common in lower extremity amputee patients and can make it difficult to utilize a prosthetic leg. Now, patients who are experiencing post-operative pain more than six months after undergoing surgery have a new option that may eliminate their pain for good.

ENDING THE PAIN: Before nerve surgery can take place, it's important for doctors to rule out any other possible causes of the pain. Infection, bone abnormality, systemic neuropathy, local scarring and underlying diseases are all ruled out before a patient is eligible for surgery.

Ivica Ducic, M.D., Ph.D., a plastic surgeon at Georgetown University Hospital in Washington, D.C., has developed a procedure that helps patients who suffer from chronic nerve pain after a surgery. "For patients who are still in pain at least six months after surgery or trauma, there are new advances in peripheral nerve surgery that can help, even when other methods and treatments have failed," Dr. Ducic was quoted as saying. Using microsurgical instruments and techniques, the damaged nerve is respected and then implanted into the adjacent muscle. Doing this protects the end of the nerve, alleviates the pain and also prevents the nerve from growing back. This procedure can ease the pain of an amputee or a patient who has undergone surgery and suffers from post-operative groin, testicular and vulvar pain.

ANOTHER APPLICATION: Dr. Ducic also developed a surgical procedure to treat migraine headaches that result from compressed nerves, also known as compression neuropathy. When nerves are contained in an abnormally tight space, they can cause a burning sensation, tingling and pain, which can result in migraine headaches. Much like carpal tunnel surgery relieves compressed nerves in the wrist, this procedure eliminates pain by reducing the tight space round the nerves, thus decompressing them. Migraines related to the forehead, temporal or occipital regions can be treated using the same-day procedure with limited and hidden incisions. To be eligible for this surgery, a patient with a history of migraines must have a work-up and at least six months of unsuccessful therapeutic treatment from a headache-specialized eurologist.