In the three years since retired Navy corpsman Ed Bonfiglio was wounded in combat, his recovery has been nothing short of a challenge, but with an innovative nerve graft surgery at Walter Reed Bethesda, he looks to a brighter future.
“I thought I was either going to have to amputate right away, or move on to something different. Then this [surgery] came along. This is amazing. This is just like a miracle for me,” Bonfiglio said.
In August 2009, Bonfiglio was attached to a Marine Corps unit in Afghanistan. While conducting combat operations, their unit was ambushed, and he was shot through his left leg – a pain unlike any he had ever experienced, he said. His leg quickly went numb, went out from under him, and he collapsed to the ground. As his fellow Marines rushed to his aide, he immediately suspected a sciatic nerve injury.
After being flown to the now Walter Reed National Military Medical Center (WRNMMC), Bonfiglio soon learned his medical instinct was right – his sciatic nerve was severed. The longest, largest single nerve in the body, the sciatic nerve extends from the lower back down to the ankle and foot.
“There was a four to five centimeter gap in the nerve,” explained Lt. Cmdr. (Dr.) Patrick Basile, assistant chief of Plastic Surgery and director of Microsurgery at WRNMMC.
Although Bonfiglio’s entire leg appeared otherwise normal, the injury essentially left him without any feeling or function below his left knee.
“I lost all movement in the bottom of my leg. I was unable to squeeze any muscles, my toes, feel anything, mostly,” said Bonfiglio.
Basile went on to note the injury was unusual, given where the nerve was severed, on his upper thigh, and that such a considerable amount of nerve was missing.
The plastic surgeon explained, before Bonfiglio, no one had been presented with this type of injury at the medical center.
Typically, surgeons can restore damage to peripheral nerves, which carry information to and from the brain, by creating a nerve graft. This is done by harvesting peripheral nerves from other areas of the patient’s own body, he explained. Peripheral nerves are found throughout the body, unlike the sciatic nerve; therefore, surgeons did not have the option of harvesting a sciatic nerve graft from Bonfiglio’s body.
Basile recalled both he and his patient were adamant about exploring every option. They considered keeping the leg, knowing it may never work again, and even considered amputation. The surgeon said he consulted other colleagues and specialists, as well as researched the possibility of trying a newer surgery being used on peripheral nerves, known as an allograft.
An allograft – an organized, scaffolding structure – is used to maintain the linear anatomy of the nerve and can be customized to fit a nerve, supporting the body’s own regeneration process. Basile explained the ground-breaking operation also allows patients to avoid incisions in other parts of the body. The decision was made to insert an allograft in Bonfiglio’s sciatic nerve, something that had not been done at the medical center. About two weeks after Bonfiglio was injured, the former petty officer underwent the single-stage surgery, which lasted roughly two hours.
In the following months, Bonfiglio underwent physical therapy almost every day, and soon went from a wheelchair to crutches, but it was not easy. He struggled to regain complete use of his leg and at times, he admitted he wanted to quit, but his therapists and Basile encouraged him to persevere.
About six months into his recovery, he could move his left foot when his therapist asked him to do so.
“I saw my foot actually move up towards me, and that was a big moment for me,” he said. Little by little, he began regaining most of the feeling and movement in his leg, though a few parts are still numb, he added.
Today, the 27-year-old said he continues to improve. He once believed he would have to rely on a cane to walk, but can now walk long distances without any aid for several hours at a time, pain free, he said. He has even started doing some light jogging – something he never thought he would be able to do again.
Now enrolled at East Carolina University, in Greenville, N.C., Bonfiglio hopes to earn a degree in kinesiology, the study of human movement. He plans to transfer to Penn State University, in Pennsylvania, where he hopes to join their Paralympic team, and compete in shot put, discus throwing and power lifting. That will require a lot of leg strength, he said, but he’s confident he can do it.
Bonfiglio recalled what helped him make it through his journey — the staff rooting for him. Basile echoed the same sentiment, thankful for the support from his colleagues, noting that since Bonfiglio’s procedure, more than 20 have been conducted at WRNMMC.
“I’m happy to be part of a group of doctors who are highly trained in a number of different disciplines, and to be able to offer this type of care to our nation’s bravest,” said Basile.