Reconstructive nerve surgery repairs farmer’s injured hand

Use of Wayne Crews' right hand is now returning following surgery by UT Southwestern Medical Center's Dr. Jonathan Cheng.

By Jan Jarvis

No one knows how long Wayne Crews lay unconscious at the farm that has been in his family for three generations.

But when the Oklahoma farmer finally freed himself from under the bulldozer that fell over on him while he was driving, his head was covered with blood and he was disoriented. He had no memory of being struck in the head, shoulders, and back with six 100-pound weights that were in the Bobcat or digging himself out from under the vehicle. 

That evening when a farm worker found him wandering around his farm in Keys, Okla., Mr. Crews told him his arm was broken. It turned out to be far worse. 

The nerves in his spine had been stretched beyond their limit, resulting in a severe brachial plexus injury. With the network of nerves in his brachial plexus unable to send signals down his arm, he was left with a right hand unable to cut a steak or write his name.

Months passed with no improvement. Surgery after surgery failed to fix the claw-like hand. Had it not been for his wife Julie’s persistence, Mr. Crews never would have found his way to UT Southwestern Medical Center, one of the few places in the Southwest that offers the complex nerve reconstruction surgery required to regain use of his hand.

Now his wife calls her husband a “miracle man” and is grateful to his surgeon, Dr. Jonathan Cheng, Assistant Professor of Plastic Surgery.

“I call him my bionic Humpty Dumpty,” Mrs. Crews said of her husband. “Only this one, they put him back together.”

The Accident

Wayne Crews was driving a Bobcat similar to this one when the vehicle fell on him.

Early in the evening of Aug. 27, 2010, Mrs. Crews got the call that her husband had been injured. Within 10 minutes, an ambulance arrived and took him to the tiny town of Elkhart, Kan., where a doctor stitched the gash in his head. His arm injury, described at the time as a simple fracture, would have to wait until Mr. Crews could be moved to a larger hospital.

The next day, Mrs. Crews drove her husband to Liberty, Kan., some 90 miles away. There, a surgeon set the arm and sent Mr. Crews home.

But a month later, he was no better, and his wife suspected something was terribly wrong. Concerned that his health was deteriorating, Mrs. Crews drove her husband to Amarillo, the closest city with a major hospital.

By the time they got there, Mr. Crews could not stand or walk. The couple soon learned why. A bleed the size of a fist was crushing his brain stem. He would need immediate surgery to stop the bleeding that was most likely caused by the pressure of being hit with 600 pounds of weight.

He survived that surgery, but his hand still was no better. His wife feared they were running out of time to fix it. 

The Surgery

Mrs. Crews kept prodding and eventually was referred to UT Southwestern in December 2010. At that time, her husband still could not open his hand or move his fingers on his own. “His hand looked like a turkey foot,” Mrs. Crews said. “And it was all shriveled up.”

From the start, Dr. Cheng told them he could fix it with a nerve transfer procedure.

During the six-hour nerve reconstruction surgery in January 2011, he did exactly that, borrowing normal nerves from working muscles in the forearm and moving them to other areas that had been damaged. Essentially, nerves from uninjured areas of the brachial plexus were used to restore movement in the paralyzed right hand. 

“It’s almost like rewiring,” Dr. Cheng said. “You give back nerves to the muscles that have lost their nerve supply.”

Soon afterward, Mr. Crews was able to move his hand. Over time, he has started to extend his fingers and open his palm up.

He still faces months of physical therapy for his hand as well as cognitive therapy to repair damage from the head injury.

But the difference is remarkable.

“Without the surgery he would have had a hand that was not functional and looked like a claw,” Mrs. Crews said. 

Mr. Crews is slowly regaining his strength and his confidence. He is determined to make a full recovery.

“I want to do everything I could do before,” he said.