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Practice News


Update on diaphragm pacemaker patient, Kevin Neary

On March 27th, 2012, Kevin Neary underwent surgery with Dr. Matthew Kaufman in an effort to salvage his phrenic nerve and install a pacemaker to get his diaphragm working. The 29-year-old graduate of the University of Pennsylvania had been on a ventilator since Nov. 15, when he was shot during an attempted robbery in Northern Liberties and left quadriplegic. Doctors thought that the damage from the bullet, which was still lodged in his neck, had impaired the phrenic nerve, which triggers the diaphragm and allows the lungs to draw in air. He was hopeful that this procedure would get him off the ventilator for six hours per day.

In a recent video that Kevin sent in shows that he is almost 100% off the ventilator and breathing on his own.

To read his full story click here

Young Spinal Cord Injury Patient Able to Breathe on His Own

Dr. Matthew Kaufman Performs Specialized Surgery to Install Diaphragm Pacemaker

Nick Andrade was a 17-year-old competitive swimmer when he took a vacation trip to his Brazil, where he has relatives. It was there that Nick dove into shallow water and suffered a spinal cord injury, leaving him paralyzed from the neck down and on a ventilator.

Eventually, when he was told he would never be able to breathe on his own, forever connected to a ventilator, Nick did not want to go on; he had lost all hope. Ultimately, he was referred to Dr. Matthew Kaufman of The Institute for Advanced Reconstruction by Dr. Wise Young, director of the W.M. Keck Center for Collaborative Neuroscience and a professor at Rutgers University, New Jersey. In July 2013 Nick underwent specialized surgery with Dr. Kaufman, including nerve grafting and implantation of a breathing pacemaker device. Today, the now 19-year-old Charlotte, North Carolina resident is starting to breath on his own, and is weaning off the use of the ventilator. Dr. Kaufman has been performing these surgeries on spinal cord injured patients in both New Jersey and at the University of California Los Angeles for the past seven years. Currently, as Nick progresses, his physicians are in close contact with Dr. Kaufman and his team.

Breathing pacemakers provide respiratory function superior to mechanical ventilators since the inhaled air is drawn into the lungs by the diaphragm under negative pressure, rather than being forced into the chest under positive pressure. This is physiologically more accurate and comfortable for the patient.

Pacing patients are also at much lower risk of upper airway infections including ventilator-associated pneumonia (VAP). Breathing pacemakers are small, and do not require the bulky tubing and batteries of mechanical ventilators, so the patient’s mobility is greatly enhanced. Breathing pacemakers can be implanted using a variety of minimally-invasive surgical approaches.

Nick Andrade’s progress is the source of great personal joy for him and his family. According to the homepage of his website www.teamnickandrade.com, “Due in large part to the generosity & support of the community, Nicholas has made great strides in weaning off the ventilator.  Now Nicholas is able to breathe for up to 3 hours on his own and we are hopeful that he will be off the ventilator before the summer.”

Making news, a new February, 2014 study published in the Journal of Trauma Acute Care Surgery finds that diaphragm pacing (DP) stimulation in spinal cord-injured patients is successful not only in weaning patients from mechanical ventilators but also in bridging patients to independent respiration, where they could breathe on their own without the aid of a ventilator or stimulation.

Dr. Matthew Kaufman has published numerous articles on this topic in the medical literature, and been a presenter at several national and international medical conferences, including more recently in Hawaii and in Vienna, Austria. On, Saturday, May 17th, Dr. Kaufman will present at the 40th annual American Spinal Injury Association (ASIA) 2014 Annual Scientific Meeting in San Antonio, Texas. His topic will be “Successful Reversal of Ventilator Dependency in Cervical Spinal Cord Injury and Stroke With Combined Upper Motor Neuron and Phrenic Nerve Lesions Using Simultaneous Nerve Transfers and Diaphragmatic Pacemakers.”

Our Doctors Author Major Phrenic Nerve Reconstruction Article

Published in The Annals of Thoracic Surgery

Includes first known published protocol for medical management of patients with diaphragm paralysis.

Functional Restoration of Diaphragmatic Paralysis: An Evaluation of Phrenic Nerve Reconstruction

click the image to view full article PDF

Visiting Doctors to Observe Our Phrenic Nerve and Nerve Decompression Procedures

The Center for Treatment of Paralysis and Reconstructive Nerve Surgery at Jersey Shore University Medical Center to host prominent European Surgeons

Margaret Romph - Phrenic Nerve Diaphragm Pacemaker recipient

Ten-year-old patient Margaret Romph from Jefferson City, Missouri with her mother Sherline after arriving at The Institute for Advanced Reconstruction. Margaret is awaiting surgery with Dr. Matthew Kaufman to implant a diaphragm pacemaker, which will allow her to breathe independently, without the need for long term ventilator support.

November 4, 2013 – Neptune, NJ – On Friday, November 8, 2013, The Center for Treatment of Paralysis and Reconstructive Nerve Surgery at Jersey Shore University Medical Center in Neptune, NJ will host Switzerland’s Andres Gohritz, M.D. and Veith Moser, M.D. of Vienna, Austria to observe several techniques in phrenic nerve and nerve decompression surgery. Drs. Gohritz and Moser will be present during a diaphragm pacemaker implant procedure on a young child. The pediatric patient suffered a spinal cord injury during a motor vehicle accident in 2009 and was left ventilator dependent.

Specialists at the Center are among a few select surgeons in the country that perform the procedure to implant a diaphragm pacemaker, allowing some patients with spinal cord injury to breathe independently, without the need for long term ventilator support. Matthew Kaufman, M.D., who specializes in treatments for swallowing disorders after stroke, diaphragm paralysis, and spinal cord injuries, will perform this unique procedure. The visiting doctors will observe this procedure and other surgeries performed by the Center’s nerve specialists: Michael Rose, M.D., Andrew Elkwood, M.D., Matthew Kaufman, M.D., Tushar R. Patel, M.D., and Russell Ashinoff, M.D.

The Center for Treatment of Paralysis & Reconstructive Nerve Surgery at Jersey Shore University Medical Center provides some of the most advanced surgical treatment of paralysis and nerve injuries in the world today.

About Drs. Gohritz and Moser:

Andres Gohritz, M.D., is a reconstructive hand surgeon at University Hospital in Basel and the Swiss Paraplegic Center in Nottwil – Europe’s leading center for paraplegia, spinal cord injuries and diseases. Dr. Gohritz’s main clinical interests are peripheral nerve surgery and functional restoration in paraplegia, nerve paralysis, and spasticity.

Veith Moser, M.D., is the chief consultant for plastic, hand and reconstructive surgery and an active professor at the University Hospital in Zurich. He also is a consultant for plastic and nerve surgery at the Vienna Trauma Hospital in Austria.

About Jersey Shore University Medical Center:

Jersey Shore University Medical Center, a member of the Meridian Health family, is a not-for-profit teaching hospital and home to K. Hovnanian Children’s Hospital – the first children’s hospital in Monmouth and Ocean counties. Jersey Shore is the regional provider of cardiac surgery, a program which has been ranked among the best in the Northeast, and is home to the only trauma center and stroke rescue center in the region. Jersey Shore specializes in cardiovascular care, orthopedics and rehabilitation, cancer care, neuroscience, nerve surgery and women’s specialty services. Through the hospital’s clinical research program, and its affiliation with Rutgers Robert Wood Johnson Medical School, Jersey Shore serves as an academic center dedicated to advancing medical knowledge, training future physicians and providing the community with access to promising medical breakthroughs. For more information about Jersey Shore University Medical Center call 1-800-DOCTORS, or visit www.JerseyShoreUniversityMedicalCenter.com.

MAKING CONNECTIONS: Specialized procedures can help repair nerves affected by surgery

Article originally published in the Asbury Park Press. Original can be found here: MAKING CONNECTIONS: Specialized procedures…

In 2011, Chet Conlon, 63, suffered two episodes of atrial fibrillation and was unable to bring his heart rate back to a normal rhythm through medication.

His cardiologist recommended a procedure known as a cardioversion, in which electricity is used to convert cardiac arrhythmia to a normal rhythm. Conlon required two of these procedures, “but the second one seemed to work,” the retired pharmaceutical R&D specialist said.

However, although the procedure likely saved his life, it triggered some unexpected consequences.

“After the second cardioversion, I had trouble breathing and the doctor noticed an elevation in the right side of my diaphragm,” Conlon said. “Additional tests confirmed that the right side of my diaphragm was nearly paralyzed and the conductivity of my phrenic nerve was impaired.

“My heart had been beating at 140 beats per minute, which could have led to a stroke or worse, so the nerve damage was the lesser of two evils,” Conlon said.

Repairing the phrenic nerve

Dr. Matthew Kaufman, a plastic and reconstructive surgeon at The Plastic Surgery Center and The Institute for Advanced Reconstruction in Shrewsbury, said that Conlon’s experience is not a common problem.

But as necessary as the cardioversion was, “because the phrenic nerve is in contact with portions of the heart, it’s possible it was susceptible.”

According to Kaufman, the phrenic nerve connects the brain and spinal cord to the diaphragm muscle, which is responsible for the respiratory force that the lungs rely on to inflate and take in air.

“Damage to the right or left phrenic nerve can be caused by inadvertent trauma to the neck, chest, spine or various parts of the body from an accident, surgery, etc.,” he said.

But while modern treatment for general nerve injuries got its start in World War II, little had been done in the specialized and lesser-seen field of phrenic nerve damage until the past decade.

“We reasoned that, if other peripheral nerves outside of the spinal cord could be repaired, why not the phrenic nerve?” said Kaufman of the expertise he has become recognized for nationally since 2007 using advanced microsurgical techniques.

Kaufman is board certified in both plastic surgery and otolaryngology-head and neck surgery, and was trained at The Mount Sinai Hospital in Manhattan. Kaufman has patients worldwide who have received his phrenic nerve surgery.

The surgery

After using electrodiagnostics to identify Conlon’s exact “zone of injury” and provide a roadmap of the damage done, Kaufman performed a precise, two-step process to help repair the 5- to 6-centimeter portion of Conlon’s right phrenic nerve that had been affected.

“First, we applied decompression to the nerve to free it up and release it from the scar tissue — or compression — that was tethering it,” he said. “Then we bypassed the blockage in the nerve using a segment of the sural nerve in the leg by the outer ankle, which is considered a standard donor nerve because it can be sacrificed and used without much collateral damage. We connected it to healthy nerve above and below the injured section.”

He continued: “Because nerves regenerate at the slow pace of 1 millimeter a day, a patient has to wait for the body to regenerate new axons through the nerve graft to the muscle,” he explained, a process that can take up to a year or more based on the length of the graft, its distance from the muscle, and the severity of the injury.

Since his three-hour surgery this July, “I’ve noticed improvement on a day-to-day basis in terms of the amount of physical activity I can do without shortness of breath,” said Conlon, who’s assisting his own recovery at home in Hillsborough with twice-daily workouts on a treadmill and regular breathing exercises to build up his diaphragm muscles.

“My heart is in a normal rhythm, my breathing is steadily improving, and I’m just looking forward to getting back to normal so I can enjoy my retirement years with my family,” Conlon said.

If you are seeking the latest in paralysis treatment and nerve reconstruction, contact the Institute for Advanced Reconstruction today.

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