Guests: Dr. Andrew Elkwood & Dr. Eric Wimmers
Presenter: Neal Howard
Dr. Andrew Elkwood is skilled in many of the latest plastic surgery techniques. In addition to his expertise in cosmetic surgery, Dr. Elkwood is an international expert in nerve reconstruction surgery for patients who have lost the use of a limb from nerve damage. He is highly skilled in microsurgery, limb replantation and microsurgical reconstruction after cancer. Dr. Elkwood is a graduate of the prestigious six-year combined B.S./M.D. program at Union College, Schenectady, New York, and the Albany Medical College of Union University, Albany, New York. He completed his general surgery residency at New York University and Bellevue Hospital, and simultaneously received a graduate degree in finance and economics from Columbia University.
Dr. Eric Wimmers is board certified in Plastic and Reconstructive Surgery by the American Board of Plastic Surgery. He is also the Chief of Plastic Surgery at Capital Health Center. He received his medical degree from Howard University in Washington D.C., followed by General Surgery training at Santa Barbara Cottage Hospital. Dr. Wimmers is a member of the American Society of Plastic Surgery, the American Society of Reconstructive Microsurgery, and the American College of Surgeons.
Segment Overview: Dr. Eric Wimmers and his colleague Dr. Andrew Elkwood, from the Institute for Advanced Reconstruction discuss being the first surgeons worldwide to perform nerve graft surgery for erectile dysfunction on the first patient ever.
Neal Howard: Hello and welcome to the program. I’m your host Neal Howard here on Health Professional Radio. Thank you so much for joining us today. Our guests today are Dr. Eric Wimmers, a reconstructive plastic surgeon and his colleague Dr. Andrew Elkwood. Together, they’re set to become the first surgeons worldwide to perform nerve graft surgery for erectile dysfunction. Welcome Dr. Wimmers and Dr. Elkwood.
Dr. Eric Wimmers: Thank you.
N: I said that you’re a plastic surgeon specializing in microsurgery. Give us just a brief background about yourself. Is this something that you always wanted to do when you went into medicine or did something happen to steer you toward this specialty?
W: No, it wasn’t a long-term plan. I went into medicine actually planning to become an emergency room physician. It changed quickly once I did my general surgery rotation in medical school and realized that I wanted to become a surgeon because I was able to apply all the anatomy and physiology that I learned and really put it through, used through my hands. Then I changed gears thinking I would become a trauma surgeon. I did a full general surgery training with that in mind but realized along the way that what I enjoyed in trauma surgery was actually the really constructive portion of it. So I narrowed my focus to become a reconstructive surgeon. After that, I worked with a hand transplant team at the University of Pittsburgh for a couple years and then went to Johns Hopkins to finish up my training before joining Andrew and the rest of the group. We do a broad variety of procedures, microsurgery. When it comes to our group is really a general statement. I mean all of our plastic surgeons do microsurgery when it comes to the fine anatomic elements that we are putting back together.
N: And Dr. Elkwood, your story is similar.
Dr. Andrew Elkwood: My side, I’m set to be a plastic surgeon from my senior year in medical school. As part of that, I became a board-certified general surgeon. I have both of those and I spent all of my time training at NYU hospital which is also associated with Bellevue Hospital. I’ve helped in reconstructive surgery that way and part of doing that kind of microsurgery, I developed that as a subspecialty. That has been a large part of my practice now. The procedures that we’re talking about today are really kind of an extrapolation of the techniques, philosophy, physiology with someone fixing nerves, let’s say in the arm. What we’re talking about today, the new procedure that we developed to return erectile function to men most commonly that had prostate cancer and using these nerve techniques to have them return the erectile function. The other causes as well, trauma.
N: You did say that specifically, not only, but at least to men who have experienced prostate cancer, some degree or another. There are all different types of erectile dysfunction.
E: You are correct. It is a broad blanket statement. How a man gets an erection is a very complex system. There are reflex pathways between the spine, the penis and there’s also the psychogenic factors that play a role in arousal, in getting an erection. There’s many different components and there’s many different of those components that can cause problems with erectile dysfunction. It could be part of the reflex arc, like say a problem in the spine. It could be psychogenic. It could be anxiety something, along those lines and another common causes vascular. Patients with vascular problems can have issues obtaining erection. There’s many different causes of erectile dysfunction and to be honest we really don’t have a good handle on treating all of these different aspects. It wasn’t long ago when it was commonly thought that if someone was having a problem with an erection that it was all in their head. It was all psychogenic but now we’re starting to see, no there’s actually a lot of different anatomical aspects to getting an erection. What our study is doing and what we’re trying to show is just one component of the erection – the neurogenic aspect of the erection. The actual nerves that go to the penis and that stimulate the vascular portions of the penis to become erect. We’re trying to show that by treating just this one aspect, that we can improve erections in this group of patients.
N: Talk briefly about this nerve graft surgery where both of you said to be the first surgeons to ever perform this type of surgery for ED.
W: That’s right. Specifically it’s a nerve transfer, is what we’re doing. The difference is that a graft is a nerve that you transplant, cut completely and transplant to a new area; whereas a nerve transfer is we’re using a nearby nerve and moving it over and reconnecting it into the nerve that goes to the penis called the cavernous nerve, that results in an erection. This is actually an idea that Dr. Elkwood came up with to use a neighboring nerve that goes into the scrotum called the genital femoral nerve. We’re using the genital branch of the general femoral nerve, which is only about three centimeters or an inch away from our cavernous nerve. Now that nerve, the general femoral nerve is used for an old reflex called the cremasteric reflex. What that is, it activates the scrotum to contract and pull upwards when a man gets into say cold water or if there is like a light tickling in the inner thigh or that kind of stimulus that the reflex is to pull the scrotum up to the body. It’s always been presumed that the reason for that is to protect the testes and protects sperm production, but the truth is no one really knows exactly why it’s there. It’s a very old reflex and aside from contracting the scrotum, it really has no real purpose. It’s an interesting option to transfer and to use to stimulate for an erection because it is part of the autonomic system that controls different parts of our body automatically. Just like an erection has autonomic control, the cremasteric reflex also has autonomic control. By applying this autonomic stimulus, transferring that over to a neighboring nerve, the cavernous nerve, the hope and the theory is that this could produce an erection.
N: You mentioned patients who have dealt with or are dealing with prostate cancer, is there something about that particular condition that lends itself better to the study and/or the procedure? Or is that just something that happens then you decided to start doing this procedure with these types of patients initially?
W: The reason why is that the nerves that are coming from the spine that become the plexus that then becomes the cavernous nerves going to the penis, they go anatomically just underneath the prostate and so traditionally taking the prostate out for prostate cancer produced a very high rate of erectile dysfunction because of injury to those neighboring nerves. That’s why we’re looking at that group. It’s not the only group we’re looking at but that group in particular is known to have a high incidence of problems where the erectile dysfunction.
E: But really in terms of just understanding it on the most simplistic level is that nerves carry electricity a lot like wires do. If there is a cracked wire or a piece of wire that’s missing, you can splice in a piece of wire and that’s a technique that we use all the time, that’s called the nerve graft. If for some reason the outlet that you’re trying to use is not working, you can take an extension cord and plug it into a different outlet, and that’s what we’re talking about here. What we often try and do with these types of procedures is, if a nerve is not working, let’s say in the case of prostate cancer because the nerve had to be removed with the cancer or that radiation caused the nerve to not function. There are times that we would go inside the abdomen and splicing nerves and so on, but it’s something you don’t want to do in a man that’s already had surgery or had radiation. The procedure that we’re talking about is to take a nerve that does what we call a synergistic function. Something that’s related to that same function and use it as an outlet. As an alternative outlet, plug in an extension cord and use it as an outlet. That’s what we’ve done. So that’s the procedure that we’ve devised. It’s a technique we use in other places in the body whether it be to make arms move again in accident victims or faces move again in patients with Bell’s Palsy or for spinal cord patients and so on and so forth. But this technique is based upon those foundational ideas with the goal of rerouting the nerves. Rerouting the nerve that causes the scrotum to retract when it is dipped in cold water and use that nerve which goes along with an erection. Every time a man has an erection, that nerve actually fires. People may not realize that. So use that as an outlet and plug an extension cord in there, essentially reroute the nerves so that when that retraction reflex happens, the brain gives a default signal to cause an erection and they go hand in hand. That’s pretty much what the procedure is in a nutshell.
N: Where can our listeners go online and learn more about this procedure and about the Institute for Advanced Reconstruction?
E: They can go on advancedreconstruction.com. That’s the website for our Institute and/or compellinghope.com which is our hospital based Jersey Shore University Medical Center. That’s our Hospital Based Nerve Institute. So even one of those compellinghope.com or advancedreconstruction.com and they could find out some information.
N: Great. I thank both of you Dr. Eric Wimmers and Dr. Andrew Elkwood for talking with us today. It’s been a pleasure.
W: Thank you.
E: Great, thank you.
N: You’ve been listening the Health Professional Radio. I’m your host Neal Howard. Transcripts and audio of the program are available at healthprofessionalradio.com.au and also at hpr.fm.