The rewiring of Tim Raglin (with video) - electric toothbrush

On a cold morning at the end of February, a medical team gathered at 7 in the morning. m.
On the third floor of the Civic Campus of the Ottawa Hospital, it will be an unprecedented day of surgery.
The goal of the team is to be bold: Get the 44-year-old Tim Lagin's right hand back to the sportyear-
The fingers have been paralyzed by frozen old limbs since August 2007.
During the citizen holiday long weekend that year, Raglin, a project manager at a high-tech company in Ottawa, jumped off the dock at his family's Round Lake cottage near Pembroke.
The cottage in his house has lived for generations.
He made the same mistake hundreds of times.
This time, however, the combination of heat waves and deep dives caused a disaster.
That year, the water level of the Round Lake was unusually low, and laoglin hit the sand bottom with force.
He was floating on the water and one of the cervical vertebrae was broken.
Now, in more than seven years, surgeons will try to recreate Raglin's paralyzed right index finger and thumb. Dr.
Kirsty Boyd, plastic surgeon at Ottawa Hospital, will have a nerve transplant
First similar operation in Canada
Guided by women who pioneered the technology at the University of Washington Medical SchoolLouis, Dr.
Susan McKinnon
McKinnon is one of the most popular plastic surgeons of her generation. Canadian-
Born and educated, McKinnon is considered an innovator using nerve transfer and a powerful preacher of the technology.
In fact, she and a colleague
Ada Fox shares their expertise in Ottawa at his own expense.
"We're here to make sure it's perfect," McKinnon said . " For the first time five years ago, he had a nerve transplant for patients with quadriasis.
Just before Raglin was pushed into Operating Room 10, the surgical team met him, where he would be under anesthesia and dressed for surgery.
He showed the assembled crowd the existing function of his right arm.
Raglin can move his shoulder and bend his elbow.
He has some ability to turn his wrist, but his hands cannot move by themselves.
His fingers were motionless in his palm.
Raglin's upper limb has movement, which makes him eligible for today's surgery because it means that there are nerves on his arm that still communicate with the brain.
None of the nerves under his spinal cord injury, including those moving his hand, were present.
The goal of the operation is to create a new route for information from Raglin's brain to reach his thumb and fingers.
To do this, the surgeon will connect one functional nerve of his upper arm to another nearby nerve, which has not been used since the date of the accident.
It was unthinkable only ten years ago that the surgery would see the surgeon cut off the end of the wrist where Raglin worked
Bend the nerves of the elbow
Connect it to the anterior interbone nerve that used to control the thumb and index finger.
The new connection effectively bypassed the spinal cord injury of Raglin.
However, this is not as simple as connecting two wires.
Although nerves carry an electrochemical signal, they are made up of living tissues.
Once the tissue inside the anterior bone nerve is cut off and connected to the wrist, it will die.
However, this process provides an empty neural tube that can guide the rerouted wrist muscle nerves as it slowly grows to the hand muscles of Raglin.
The arm muscles can be redeployed to operate the hand of Raglin as it is built into the nervous system-
Redundancy: The arm has three nerves to help bend the elbow.
McKinnon explains the concept behind her breakthrough: "There are 3,500 motor fibers in the wrist nerves, and in this patient he doesn't need them.
They are connected to the brain.
He doesn't need them. they are connected to the brain. That’s the key.
Because there are some nerves below that are not connected to the brain, but into very healthy muscles --
Just hope they can talk to the brain.
Mackinnon described this in another way, saying that the surgeon will reschedule Raglin's nerve traffic to avoid his spinal blockage by putting it on his arm
"Instead of going to Toronto via Highway 401, we went to Toronto from the back door: on Highway 7," she said.
The new route, however, requires considerable patience from the lagelin.
It will take six to nine months before he can know if the operation works.
This is how long the arm muscle grows along its new neural pathway to the muscles in the hand.
If the surgery is successful, Raglin's thumb and index finger should slowly recover later this year.
A few months later, once he learned to control his hand, Raglin wanted to feed himself some grapes, perhaps a potato chip or two.
He said: "Even being able to pick up paper towels to blow the nose is a bit better than what I can do now.
Tim Green calls himself the luckiest unfortunate person in the world.
"I was unlucky, but I have been lucky since then," he said . ".
His good fortune began with a decisive disaster in his life.
The green hit the bottom of the Round Lake and it was dark.
As he regained consciousness, he lay down in the water face down, staring at the bottom of the lake, unable to move.
"I knew what was going on right away.
I know what this is, I think, "Well, no, it's not good.
I know the clock is ticking.
I only have so much air.
I held my breath as long as I could, and then I passed out again.
"Raglin jumped into the lake before dinner to cool off.
Fortunately, his friends and relatives reacted quickly: laglen was unconscious when he was pulled ashore, but his sister and brother --in-law —
Two OPP officials
Trained in handling such emergencies.
An air ambulance was dispatched.
"I woke up on the beach and was surrounded by people who made sure I was OK and comfortable," Raglin said . ".
He was lucky to rest at the bottom of the neck because higher cervical lesions caused more severe paralysis.
In the nine months of the Ottawa Hospital rehabilitation center, Raglin learned to make the most of the limited movements of shoulders, arms and wrists.
His mother also made Velcro cuffs for him and attached a pointer that he tied around each palm.
These devices enable him to navigate on tablets, phones, and remote devices. Now on long-
Raglin says he's always been good at being alone --
He reads, watches documentaries and follows the news
Fortunately, Natali Mainville is in his life.
They met through friends and got married in Las Vegas last year.
The couple and her two children now have a spacious home in Carp with the House backed by the forest.
A friend of Nathalie pointed out that Raglin was a surgical breakthrough written by Dr.
Susan McKinnon in St.
Louis, Missouri
In May 2012, the report of the operation was published in the Journal of Neurosurgery.
About two years ago, Raglin asked his rehab therapist if there was such an operation in Ottawa.
His physical doctor introduced him to plastic surgeons in Ottawa.
Kirsty Boyd, who happened to know McKinnon and her job.
Boyd finished a year.
Long-term surgical cooperation with McKinnon in June 2011
Six months before joining the Ottawa Hospital.
The focus of the Fellowship is on nerve metastasis.
"I didn't do this in this patient group (with quadriasis), but I'm willing to try," Boyd told Raglin . ".
At that time, it was not clear whether Raglin was eligible for surgery.
But the test by the doctor
Gerald Wolf
The founder of the peripheral neurotrauma clinic in Ottawa determined that he was an ideal candidate because his arms and hand muscles were goodpreserved.
Boyd and wolf head to St.
Louis consulted McKinnon last year.
At some point Boyd admitted that she was "a little nervous" about trying this type of surgery ".
"We will come," McKinnon announced . "
At the end of February, this series of accidental events led Raglin through the gate of operating room 10, followed by some of the world's leading peripheral neurosurgeons.
Six doctors and residents are watching.
Boyd cut the right upper arm of laoglin and unwound the muscles, arteries, tendons and nerves.
Boyd began looking for the two nerves she needed to reroute the signals of Raglin's brain to his hands.
The nerves are bigger than you think.
Looks like cooked pasta. With Dr.
Boyd is by her side, providing guidance and encouragement to carefully isolate the noodles
Like the nerves of the meatier muscle, use a red and yellow ring that looks like a colored string.
When explaining nerves to patients, Boyd likes to use spaghetti as a metaphor.
The surrounding nerves are basically like a bag of pasta, she says: There's a plastic wrapping paper and a bunch of noodles inside.
Solving all this is a challenge.
"In addition to this decision, the most difficult part of neurological surgery --
"Manufacturing is what is found," said Boyd . ".
Once she had separated what she wanted, Boyd carefully cut the shell to reveal the smaller nerves that were tied inside.
She must now determine which one is connected to the muscles of the index finger and thumb.
Boyd uses an electric toothbrush-sized hand-held nerve stimulus to provide a tiny charge to one of the exposed noodles.
The wrist of LA Green rotates accordingly.
With the help of McKinnon, Boyd continues to explore the exposed nerves until he touches the finger and thumb of laoglin during a spasm jump.
The surgeon has found the "recipient" nerve, the interbone anterior nerve (AIN), which looks like any other healthy nerve.
Although its electrical signals cannot pass through the brain, the nerves still receive blood and nutrients from the connection to the spinal cord.
However, once the surgeon has cut off the connection, the nerves begin to die and melt.
However, its shell will remain the same as the "pipe" of the working arm nerve following the fingers and thumb.
About 90 minutes after the operation, she stared through something that looked like a small telescope --
Surgical blinds
Boyd cut off two nerves and folded them up.
Then, when using a microscope to further amplify her strict surgical work, she put them together.
Three hours after the operation began, Boyd closed the original incision.
In the afternoon, the surgical team performed a second nerve transfer on Raglin's right forearm in an attempt to further improve his finger extension.
Later, at the buffet in the hospital, Boyd announced that he was very excited about the operation of the day.
"Everything went well," she said . "
For Boyd, however, the worst part of the program is about to begin: Wait.
It takes six to nine months for her patient's hands to show any signs of life.
The long-term wait for the results of nerve transplant surgery depends on the rate of regeneration of the cut-off nerve.
The wrist nerve cut off in the bicep of laglen will grow along its new pathway, just like the stem of the trimmed grape --
Until it reaches the muscles of his thumb and fingers.
The nerve has to stretch about 20 cm to the fingers and thumb, but it is only 1mm long a day.
"It will be very difficult," Boyd said of the waiting process . ".
"Even if it takes three months for my other nerve transfers, I am impatient.
We saw them in the clinic and I was wandering to see if there were any signs of recovery.
The daughter of two doctors in London.
Boyd decided early in her medical career that she wanted to be a surgeon because she liked the instant reward for it.
"I like that you can go in right away and see and fix a problem and then fix it," Boyd said . " She allocated her time between breast reconstruction surgery and peripheral nerve surgery.
Raglin will start intensive physical therapy and learn how to use his hot silk hand once there are signs of nerve growth.
If everything goes according to the medical script, the nerve signal used later this year to bend Raglin's elbow will trigger the squeeze of his right thumb and index finger.
McKinnon has no doubt that this operation will succeed: it is a strict law of anatomical engineering for her: "You find the right nerves and then connect them together.
But Boyd is anxious to prove that she can replicate the results of McKinnon.
"I will be very happy when I see these transfer jobs," she said . ".
A week after the operation, Tim Lagin sat under the lights
His carp family is packed with the living room, waiting for his miracle.
"The arm is very angry with me now: there is a lot of muscle cramps," he said . ".
"But I can still move my elbow: It's not as strong as it was before, but I can still do it.
"Waiting for his nerve regeneration will be the easiest part of the Raglin nerve transfer program.
He is very good at waiting.
"In my case, you have to learn to be patient," he said . "
"Also, my expectations are pretty modest: I want to get more independence and take care of myself better.
"I may not be able to feed my own chicken wings, but it would be great if I could pick up some potato chips or grapes and maybe hold a toothbrush.