Choosing Amputation Over Pain

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Morgan Stickney was a US Olympic swimming hopeful — until uncontrollable pain after a seemingly innocuous foot injury forced her to consume opioids to the point where she could no longer focus on her studies. In this story at the New York Times, David Waldstein reports on how hope came out of tragedy: the ground-breaking leg amputation surgery Stickney had maintains the critical connection between muscles, nerves, and the brain that could allow for greater success with robotic limbs currently under development. The surgical research and breakthroughs were funded in part by the Stepping Strong Center for Trauma Innovation — an organization started by the family of Gillian Reny, one of the victims of the Boston Marathon bombings in 2013.

Named the Ewing amputation, after Jim Ewing, the initial patient, the procedure is thought to be the first significant change to amputations in hundreds of years, Carty said.

During standard below-the-knee amputations, the muscles in the back and front of the lower leg, which naturally work in tandem, are shorn of their connection. In the new procedure, Carty uses material from the discarded portion of the limb to reconnect those tissues and the nerves that serve them. Doing so preserves the natural connection of the two muscles and the communication with the brain, he said, and, in most cases so far, allows them to work in concert as before.

Carty said he had been thinking of a better way to do amputations when the Boston Marathon bombings occurred in 2013. He and his colleagues treated dozens of victims after the attack, many of whom required complex reconstruction of their lower limbs. The family of one of the victims that day, Gillian Reny, donated $2 million to establish the Stepping Strong Center for Trauma Innovation, which has helped finance Carty’s research, in collaboration with Hugh Herr, the M.I.T. scientist who is developing the robotic ankle and foot that Stickney and other amputees have tested in his lab. The Department of Defense has since provided an additional $6 million to help develop more sophisticated approaches to amputation.

Tony Stickney, Morgan’s father, initially opposed it, and even tried to dissuade his daughter as late as the day of the operation. But she was resolute.

“She wanted to be out of pain, and I didn’t know what else to do as a dad,” he said. “I knew we were losing her to the drugs. Dr. Carty’s surgery provided some hope.”

During the operation, Carty discovered that one of Stickney’s metatarsal bones — the five long bones in the foot — had died, probably as a result of the earlier staph infection. What he saw confirmed that any additional procedures to salvage the foot would have failed. Stickney’s decision to amputate only hastened the inevitable.

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