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Extremity Reconstruction Helps Relieve Pain and Provide Hope for the Future

Gary Jones in a boat holding a large fish
Gary Jones enjoying a day of fishing

Gary Jones used to be the person everyone could count on to help out when they needed it. He was one of the hardest workers his daughter Linlee knew, usually clocking more than 20,000 steps a day and rarely sitting down to take a break. But that was all before a surgery that left him in excruciating pain 24 hours a day, every day of his life.

It started a little under five years ago when Gary had neck surgery for persistent pain. According to the surgeon, the procedure was a success and should have eliminated—or at least significantly reduced—his pain. But in a post-operative follow-up appointment, he told the surgeon he still had pain in his forearm.

The surgeon checked for all the usual issues like blood clots but couldn’t find the source. She sent him to the emergency room to get some additional tests done. Within an hour, Gary was on an operating table getting treatment for multiple severe abscesses in his lower arm. They were all infected with Methicillin-resistant Staphylococcus aureus (MRSA) bacteria. MRSA is dangerous because the bacteria is resistant to most antibiotics that doctors use to treat staph infections. 

Gary’s infection was so bad they had to operate on his arm multiple times over the course of several days. The infection was still spreading at first, so Gary was sedated while doctors discussed the possibility of amputation with his family members. Fortunately, during the third surgery, doctors could see the infection stop spreading. They were able to clean the wound and put on a wound vac. Within a few days, Gary was discharged from the hospital and on the road to healing. 

But there was another problem: after all those surgeries on his right arm, Gary had no function in his right hand. He couldn’t make a fist or wiggle his fingers. For a right-handed professional painter, the disability in his hand meant he couldn’t work. He also had to learn to perform daily tasks like eating and signing his name left-handed.

“It was a scary feeling after coming out of the sedation to learn that I almost lost my arm,” Gary said. “But I felt grateful and blessed that the infection didn’t spread.” 

As Gary was healing, he started to feel severe and excruciating pain in his right forearm. By the time he saw the surgeon for his one-year post-operative appointment, the pain was debilitating and interfering with his daily life.

The surgeon offered to perform a nerve conductive test to find out where the pain was originating. But Gary’s daughter Linlee, who is a nurse, was worried that test might increase his risk for another MRSA infection. The surgeon sent him to a pain clinic instead. 

Pain specialists tried a few tests to find out what was causing the pain but could never pinpoint the source. The best they could do was prescribe opioid painkillers in ever-increasing doses as his body developed a tolerance over the years. 

“When you get on those pain medications, I don’t care who you are, it changes your personality,” Gary said. “My life went in the toilet when I was taking those drugs.” 

His family noticed the changes too. His wife Denise knew it wasn’t safe for him to drive, so he had to be chauffeured around anytime he wanted to leave the house. He couldn’t watch the grandkids alone because he might fall asleep, and he didn’t trust himself to hold his youngest grandchild for fear his arm might fail and he would drop them. His favorite hobbies, like hiking and hunting, were off the table too. 

On top of all that, he was still experiencing the most intense pain imaginable. Gary described it like the feeling of hitting your funny bone, but not for the few seconds most people experience that pain—instead, it was all the time. “It was a nine or 10 on the pain scale, like someone had my arm in a vice and was repeatedly smacking it with a sledgehammer all day, every day,” he said. 

He knew he needed a second opinion. His brother happened to be visiting a friend in Utah County who recommended a surgeon at U of U Health that might be able to help. They called Christopher Goodenough, MD, MPH, a plastic and reconstructive surgeon at University of Utah Health, Assistant Professor in the Department of Surgery, Division of Plastic Surgery and scheduled an appointment. 

Dr. Goodenough, an assistant professor in the Department of Surgery at Spencer Fox Eccles School of Medicine, trained as a plastic surgeon with a focus on nerve and reconstructive microsurgery. He specializes in complicated hand and upper extremity injuries. Most patients he sees have severe trauma after a car or motorcycle accident, or an industrial accident at work. 

After their initial appointment, Dr. Goodenough spent some time researching Gary’s situation. He ordered an MRI and CT scan, along with some other tests. He consulted with the surgeon from Gary’s original procedure to confirm the details of the surgery and the postoperative course. He found where the nerve was misfiring and felt confident that surgery could help with Gary’s pain. 

“He asked me, ‘What is your end goal?’ and I told him that I wanted to get off the pain medication,” Gary said. “If I could get function back in my hand, that would be a bonus, but if not, no big deal.”
Gary Jones reconstructive surgery patient
Gary Jones arm being examined by Dr. Goodenough following surgery
Gary Jones' arm following reconstructive surgery by Dr. Christopher Goodenough.

Dr. Goodenough found significant scarring in the tissues where Gary had abscess surgery. It encased the nerves that go down into the hand. Most of us know them as the “funny bone” nerves.

“The first step in the surgery would be to release the scar tissue, freeing up that nerve and giving it more space,” Dr. Goodenough said. Because that nerve gives function to muscles in the forearm, the entrapment was a likely suspect for Gary’s compromised hand function. 

“When your body is trying to heal, everything sort of sticks together to heal the area,” Dr. Goodenough explained. “But after the healing is complete, that tissue often shrinks. In this case, that contraction was happening right around Gary’s nerve.” 

There was still a risk that more scar tissue could form and the pain would come back. So Dr. Goodenough also inserted a collagen wrap around the nerve. This provides a barrier where scar tissue can adhere, keeping it away from the nerve. Eventually the wrap breaks down and the body absorbs the collagen tissue. 

Before the surgery, Dr. Goodenough prepared Gary for the range of outcomes. He might need more than one surgery. He might get only partial pain relief. Other reconstructive surgery options might help Gary regain function in his hand later. As with any surgery, there were additional risks like bleeding and infection. With Gary’s history, the infection risk could be serious. But Gary was willing to take the risks.

Gary vividly remembers the feeling when he came out of anesthesia and the surgery pain medication started to wear off. “I could immediately feel that the excruciating pain was gone,” he said. He scheduled an appointment as soon as he could with the pain clinic to talk about getting off the opioids. They gave him two options since he had been taking such high doses for so long: go off completely and spend a few days in the hospital to “detox,” or wean his body by gradually lowering the dose. He chose the latter. 

That was in March 2023, and he is still on track to be off the pain medication by the beginning of 2024. Gary gets emotional thinking about what a difference Dr. Goodenough and the surgery have made in his life.

“I didn’t think I would ever be able to use my hand again and not be in so much pain all the time,” he said. “My life is a lot better when I’m not in so much pain. I’m not such a grumpy old man. I feel like I’m being useful in the world now instead of just a blob on the Earth."
Gary Jones reconstructive surgery patient

For his family, the difference is night and day. “Me and my brothers have our dad back,” said Linlee. “Before, it didn’t feel like we had a dad. He couldn’t do anything. He would try to help out or be present, but it wasn’t the same.” 

Gary also notices cognitive and mental health improvements. His brain fog is gone, and he can remember things better. He also doesn’t feel so bleak about a future where the only choice was to continue on high-dose pain medication. He can go out with family on hikes and look forward to spending time with his three children and six grandchildren.

Surgery had another unexpected benefit: His “mannequin hand” that had no function now has movement again. He can feel his pinky finger for the first time in years and wiggle his fingers. He still experiences some bursts of pain as his nerve function returns—what Dr. Goodenough calls “little zingers”—but at least he knows that temporary jolt of pain won’t last.

For Dr. Goodenough, Gary was exactly the kind of patient he wants to help. “We have seen a lot of developments in the last 10 to 15 years taking care of patients with chronic pain from damaged nerves,” he said. “But outside of the small group of surgeons that do this work regularly, not many people know that we can address their pain.” 

That’s welcome news for people like Gary, who often come to believe high-dose pain medications are their only choice. Even 10 or more years following initial nerve damage, some patients could still get relief. “Surgery might not take away all the pain or completely restore function, but it can make life a lot better,” Dr. Goodenough said.

“Dr. Goodenough has a great personality and really explained everything,” Gary said. “After so many other doctors couldn’t do anything about the pain, it meant so much to hear him say I was in the right place and he could help me.”