Alex Woollard studied nerve regeneration at the Centre for Brain Science at Harvard University under Professor Jeff Lichtman. His PhD thesis compared the efficacy of neuromuscular junction rein nervation after nerve repair or nerve graft. To that end he worked with transgenic mice that exhibit Yellow Fluorescent Protein in their peripheral nerves (YFP-16 and YFP-H). Through the use of confocal and two-photon microscopy he studied the behaviour of the regenerating axons and the patterns of neuromuscular junction reoccupation.
Neuroma at the site of neurorraphy
This is an example of axons crossing the site of a nerve repair. It is fascinating how order can turn to chaos and return to order in the space of a few microns.
patterns of reinnervation
The natural fluorescence of the axons coupled with immunohistochemical labelling of the junctions provided distinct two-wavelength identification of reinnervated junctions. This revealed the patterns of reinnervation as the axons regenerated.
Changes at the nmj
Reinnervation brought many subtle changes at the neuromuscular junctions. Polyinnervation, partial innervation, new junctions forming de novo, junctions innervated in series rather than parallel and loss of NMJ gutter integrity.
Targeted Muscle Reinnervation
As part of Relimb Alex Woollard is actively pursuing innovative approaches to prosthetic control by ‘rewiring’ the residual nerve and muscle targets in amputees. Very little has changed in the world of amputee reconstruction since Pare’s Napoleonic design. The advances in materials, batteries, motors and myoelectric prostheses, coupled to the revolution in osseointegration, and now TMR, are opening up a bright new future for function. Relimb is right at the very crest of that wave. We are also advancing new horizons in implantable electrodes and plug and play devices in collaboration with Dorset Orthopaedic, the very best rehabilitation, physiotherapy, occupational therapy and prosthetic experts to deliver bespoke solutions.
Dumanian, in his pioneering work on TMR with Kuiken, recognised the windfall TMR seems to effect on both neuroma and phantom limb pain. We have begun a prospective randomised control trial (RCT) to investigate just how effective this treatment is. We aim to ascertain whether TMR should be the gold standard for controlling nerve pain in primary amputation.