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August 26th, 2015

Experimental Nerve Graft Puts Former Green Beret Back on his Feet

By Hoyt Finnamore

Kevin Flike with his daughter, Lilah. Others might have panicked, but former U.S. Special Forces Engineer Kevin Flike kept his wits about him when he was shot in the abdomen during a firefight in Afghanistan four years ago. Through the worst pain of his life, the Green Beret pushed forward. He radioed his injury to teammates and began assessing the wound, which appeared mortal to his unit’s medic.

“I wanted to remain calm because I knew if I wasn’t, it was going to make the situation worse,” says Kevin, who, at 27, was one of the senior members in his unit. As it was, the situation was bad. The bullet tore through his lower abdomen, breaking his hip, damaging his colon, and ripping apart his left femoral nerve. 

Following field surgery to stabilize the wound, Kevin was airlifted to an Army hospital in Germany, where he underwent the first of many operations to repair extensive abdominal damage.

When he awoke, it was clear his recovery would be slow and difficult. But the calm, steady attitude he displayed on the battlefield powered him through a years-long recovery that ultimately led him to pursue an experimental surgery with Mayo Clinic neurosurgeon Robert Spinner, M.D.

“The bullet fractured my hip, so I couldn’t walk for a couple of months,” says Kevin. Even after his pelvis healed, his left leg remained numb and unresponsive to muscle command. “Everyone was telling me I’d have some nerve damage and not to worry because it’ll come back.”

At the time, Kevin lived in Washington state, near Fort Lewis. He spent the next several months working with the best Army’s physical therapists, but nothing changed. An electromyogram revealed that his femoral nerve lacked the necessary connectivity.

“When I found out that my nerve was damaged and nothing was going to happen unless there was some intervention, it was devastating,” says Kevin, who currently resides in Boston with his wife Kim and daughter, Lilah. “The whole time I thought I could will myself to get better. I was a Green Beret, I prided myself on physical fitness." He struggled with the thought of what he'd miss out on.

The same determination that propelled Kevin to become an elite soldier pushed him to find healing.

“The whole time I thought I could will myself to get better. I was a Green Beret, I prided myself on physical fitness." - Kevin Flike

“I went to the University of Washington and a saw neurologist there — he could barely make heads or toes of the MRI because there was so much damage,” he says. The neurologist suggested Kevin go to Mayo Clinic.

Mayo's Dr. Spinner remembers getting the call from Kevin's physician.

“(He was) describing an unfortunate situation involving a blast injury with multiple abdominal injuries and no femoral nerve function,” says Dr. Spinner, who met Kevin for the first time in February 2012. “He’d had several abdominal surgeries, and it didn’t seem hopeful.”

Nerve grafting has been available for a number of years, Dr. Spinner says. But the location of the damage — the pelvis — was an uncommon one for such reconstruction. Complicating matters more was the abdominal damage and web of scar tissue essentially blocking access to the site of the nerve injury.

“The last thing you want is to do something to help someone and then make him worse. First, do no harm,” Dr. Spinner says. “I think many people would not think to do it. They’d think it would be too risky.”

But Dr. Spinner, who was impressed by Kevin's drive and upbeat attitude, determined that this risk was worth the gamble to try to restore the loss of quadriceps function.

“It would be very difficult, but I thought it would be worthwhile trying it in such a young, athletic type of individual,” Spinner says.

On meeting his new surgeon, Kevin was ready to move.

“When you’re talking to a surgeon about an experimental surgery, you want there to be a certain level of confidence in their voice — and he had it,” he says.

To maximize the chance of success with the graft, Dr. Spinner knew he’d need help getting access to the nerve. So he recruited general trauma surgeon Scott Zietlow, M.D., to join the team and assist in creating a pathway to the injury.

During the several-hours-long, multi-phased operation, Kevin's abdomen was opened and a path to the injury cleared. Nerve tissue was harvested from the lower portion of his left femoral nerve, which attached to the skin of the shin and inner leg. And multiple cable grafts were performed bypassing the zone of injury, connecting the femoral nerve in  Kevin's pelvis and upper thigh.

"When you’re talking to a surgeon about an experimental surgery, you want there to be a certain level of confidence in their voice — and he had it." - Kevin Flike

When he came out of the anesthesia, Kevin was in an incredible amount of pain, but he had a gut feeling the surgery had been a success.

“I stretched out and felt my leg jump, and I just knew,” he says. Kevin was released a few days after the surgery and began physical therapy at Mayo that continued back in Washington with renewed purpose. With restored nerve connectivity, his function slowly began to return.

“One of the things I would do is sit on a bench and stretch out my leg,” Kevin says. "I’d load it with a couple hundred pounds, and even though I couldn’t move it, I would press against it as hard as I could to get the neural connectivity going.

“Nerve growth is like an inch a month, so I would notice a little movement and then a little more, and then one day I’m sweating like I’m running a marathon, and I could finally raise my leg," he says.

While Kevin has not yet returned to actually running marathons, earlier this summer he ran a mile in less than ten minutes. It was a milestone and a profound achievement for him.

Dr. Spinner credits much of Kevin's progress to his determination. “He’s such a high-demand, nice guy with a full life, and I think the situation would’ve been quite different had he had a different temperament and not gotten some recovery here,” Spinner says.

Kevin couldn’t agree more.

“Dr. Spinner put the thing in action and was able to luckily hand me over to these people who spent time every day to make sure and see what he did come to fruition,” he says, “So many people made this thing happen — from the inception of us calling, the care afterward, every aspect of the hospital. It’s a well-oiled machine and made what is a very difficult process of an invasive, experimental surgery as easy as possible.”

He says that despite the risks, he would urge anyone in a similar position to proceed with such a cutting-edge therapy.

“I would say 100 percent. Otherwise, you’ll just regret it for the rest of your life.”

Kevin currently resides in Boston with his wife and daughter and is pursuing dual masters’ degrees in business administration and public administration through Massachusetts Institute of Technology’s Sloan School of Management with the Kennedy School of Government at Harvard University.


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Tags: Dr. Robert Spinner, Dr. Scott Zietlow, General Surgery, nerve graft, Neurology & Neurosurgery, Neurosurgery, Peripheral Nerve Injury

Comment


Jdutreaux
@Jdutreaux

Posts: 1
Joined: Oct 21, 2015
Posted by @Jdutreaux, Oct 21, 2015

I just want to cheers this war hero and am so pleased he made it through. Great job Mayo Clinic for sharing this story!

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