Rewiring mind and body after a complex injury

Mr Marco Sinisi, consultant neurosurgeon and peripheral nerve specialist, specialises in reconstructive work after paralysis – and he has worked successfully with everything from professional sporting injuries to accidents and falls.

"I’ve seen nerves as flat as a sheet of paper in surgery," says Mr Sinisi. "With complex trauma, there will be soft tissue damage and bony fractures along with nerve damage."

“Nerve surgery is intimately related to orthopaedic surgery,” he explains, “because the force that damages the nerve is the same as that which damages bone and tendons – whether it’s from a direct blow, or a secondary injury stemming from the initial trauma. So, the first task is to understand how the function of the nerve has been affected, and whether it can be restored.”

Assessing nerve damage

Mr Sinisi is regularly called upon by fellow consultants to assess whether a patient’s nerve damage should be addressed surgically. In some instances, no intervention is needed, but often surgery can be helpful. In other cases, where the nerve and surrounding muscle tissue have be affected, the patient will need a tendon or muscle transfer to restore activity.

“Once we’ve removed any constriction and scarring around a nerve, the nerve itself will often return to its original shape and function,” says Mr Sinisi. “I’ve seen people go back to playing professional sports after severe injuries, when we weren’t sure they’d ever walk again.”

Restoring function and resolving pain

Nerve surgery is highly intricate work, with much of it done under magnification. As well as repairing injured nerves following trauma, Mr Sinisi addresses the surgical needs of the peripheral nervous system, including lesions, tumours, nerve deficits and post-operative nerve damage. For a patient living with ongoing nerve damage, the discomfort can range from intense, unmanageable pain and hyperesthesia (hypersensitivity of the outer skin layer) to complete lack of sensation and muscle paralysis.

"A procedure to improve a joint may have gone well, but somehow there can still be a damaged nerve leaving the patient with continuous burning, tingling or hypersensitivity. It’s horrendous for the patient – but completely possible to treat surgically."

Mr Sinisi says any unexplained pain should be referred to a nerve specialist for investigation as early as possible to maximise positive outcomes. "The sooner we catch these cases, the better our chance of successfully restoring function and resolving pain."

One of just a handful of surgeons in the UK who specialises in treating disorders of the peripheral nerves, Mr Sinisi’s role is to assess the extent of the nerve damage and work out the best treatment options.