Nerve injuries in military personnel focus of new School of Medicine Web site

Military physicians treating solders with nerve injuries to their arms and legs will soon be guided by a multimedia Web site under development by plastic and nerve reconstructive surgeons at the School of Medicine.

“In combat, injuries to extremities resulting in peripheral nerve damage are becoming more common,” said Ida Fox, M.D., assistant professor in the Division of Plastic and Reconstructive Surgery and a co-principal investigator on the project with Justin Brown, M.D., assistant professor of neurosurgery. “We hope that by providing this resource, we can dramatically streamline and improve the approach to complicated nerve injuries, resulting in better patient outcomes.”

Peripheral nerve injuries common in soldiers range from a crushed or cut nerve to a gunshot wound that injures the brachial plexus, a network of spinal nerves that begins in the back of the neck, extends through the armpit and conducts signals from the brain to the arm and hand. While physicians have made great strides in saving damaged limbs, the nerve injury also must be reconstructed for the ultimate benefit, Fox said.

The interactive, multimedia Web site will serve as an educational resource to military physicians by providing answers to questions about nerve injury management, triage, diagnosis, the latest surgical techniques and procedures, postoperative therapy and anatomy and physiology. In addition, it will provide videos of procedures and exams, graphic illustrations, photographs, text and links to a variety of useful resources.

“Text and figures provide a two-dimensional answer to a three-dimensional problem,” Brown said. “The addition of high-definition, narrated videos, an interactive platform, computer-generated animation and a discussion format provides the surgeon with answers that translate easily into practical application.”

Military physicians also will be able to ask questions and share information through an interactive forum with Washington University surgeons, who will provide direct counsel among physicians regarding complicated patient cases, Brown said.

The School of Medicine’s Division of Plastic and Recon-structive Surgery is among the few international centers that have developed emerging methods in using nerve transfers. Susan E. Mackinnon, M.D., the Shoenberg Professor and chief of the Division of Plastic and Reconstructive Surgery, is a pioneer in the treatment of peripheral nerve injuries. She established her international reputation as a surgeon in 1988 by completing the first successful peripheral nerve transplant. This restored function to severely injured limbs that previously were considered irreparable. She is considered an international authority on nerve regeneration, nerve transfer and on the use of limited immunosuppression in nerve transplant patients.

Other collaborators include Mackinnon; Thomas H. Tung, M.D., assistant professor of plastic and reconstructive surgery; and Christine Novak, a physical therapist with the Wharton Head and Neck Centre in Toronto.

The physicians will maintain the site for at least five years. Funding for the project is provided in part by the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc.