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More Elective Amputation

March 19, 2012

Nicola Wilding, 35, lost the use of her right arm in a car crash 12 years ago.

Nerve transplants have returned some movement to her upper arm, but she’s been told she’ll never be able to use her hand again.

Now, having seen a Newsnight film on the work of Austrian surgeon Oskar Aszmann, she is actively considering having her hand cut off and replaced with a bionic prosthesis.

“Twelve years ago on the motorway coming back from Brighton I had a crash,” she says, in the kitchen of the Surrey home she shares with her parents and son.

“In the impact I brought my arm up to protect my head and it’s pulled the nerves and the shoulder back. I broke the bones straight across – compound fractures I think here and here,” she continues, slicing her good hand across the sites of the breaks.

The bones could be fixed, but the injuries to her brachial plexus, the complex set of nerves which run from the neck via the shoulder to the arm, were always going to prove more problematic.

Her entire right arm was left paralysed by the crash, so surgeons performed nerve transplants, taking tissue from her leg and the side of her torso, to try to restore some movement.

Slowly and with the help of physiotherapy, movement returned to her upper arm. But the hand remained paralysed and withered.

“My doctors are like ‘That’s all we can do for you’,” she recalls.

Nicola remained frustrated, and still is.

“It’s the everyday things. If you go to butter toast you can’t hold it. I’ve used my teeth to open bottles and chipped some teeth. Taking my clothes off, having a shower. I have to have meals prepared for me – I can’t peel a potato as much as I’ve tried. I’d probably end up injuring myself.

“There are things I just can’t do.”

Then, last May, she saw a Newsnight film in which Austrian resident Milo underwent elective amputation to have his withered hand replaced with a prosthesis. He had suffered a brachial plexus injury in a motorbike accident, and had also lost the use of his hand.

The film also featured Patrick, the first patient to undergo the procedure, who was already showing off his bionic hand, opening bottles and tying his shoelaces.

The surgeon was Oskar Aszmann.

“I saw the clip of Oskar, and I was just filled with hope, because it could be life changing.”

London meeting

Nicola contacted Mr Aszmann immediately, but it’s only this month that she has had the chance to meet him.

The surgeon was giving a lecture on his work to doctors at St Thomas’ Hospital, London. Nicola attended the lecture and then met the surgeon for an initial consultation.

In a small room off a hospital ward, Mr Aszmann asked her how she was injured and what treatment she had had. He examined the arm, asking her what she can and cannot feel, and saw what movement she has.

But he was also keen to quiz her on her motivations and her expectations for elective amputation.

“These are risky decisions – they are irreversible. Once the extremity is gone it’s gone, you cannot put it back on again,” he says after the meeting, but he believes Nicola is a good candidate.

“She’s already ready to go. She says she wants to have a functional hand and arm, so I think for her there’s no question in her mind.

“What we have to figure out is what she still needs to qualify for an elective amputation and I think for that she will need to come to Vienna for us to conduct thorough tests.”

That will involve testing the electrical output of nerves in her lower arm, to see whether they will provide sufficient signals to steer a bionic hand.

More surgery might be necessary to improve movement in the arm, he says. There may also be surgery he can perform to reduce the persistent pain Nicola suffers in her arm.

Nicola herself seems inspired by the lecture and by her meeting with Mr Aszmann.

“If the possibility is there and I feel that I haven’t gone through with that, then I’ll feel that I’ve let myself down.

“I’ve come this far and this is another door to be opened, so yes, I’m all for it, whatever the outcome, whatever happens, it’s all good.”

She now has to plan her trip to Vienna, and then, should she be selected for elective amputation, she’ll have to think about where she can raise the money, not just for the surgery, but for a lifetime’s worth of prosthetic hands and maintenance.

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