University Hospitals Birmingham NHS Foundation Trust (UHB) is developing a specialist hand surgery service to help treat both military and civilian casualties.

The Birmingham Hand Centre, based at UHB, deals with all types of hand surgery and is now the largest unit of its kind in the UK.

But the hand service is looking to expand further, by developing a service for treating injuries to the brachial plexus, a network of nerves that begin at the spinal cord in the neck and control the hand, wrist, elbow and shoulder.

Once the new brachial plexus service is fully established, the Trust estimates there will be sufficient demand to treat around 24 cases a year, with half likely to be military casualties, including servicemen and women injured in Afghanistan.

Dr Prem Mahendra, UHB Divisional Director, said: “The hand service at UHB has expanded considerably over the last five years, both in terms of infrastructure and referrals.

 “The Birmingham Hand Centre, as it is now called, is the largest hand unit in the UK and has a reputation for clinical excellence in hand surgery.”

Dr Mahendra said the hand centre had established referral patterns from hospitals across the region, both emergency and elective cases.

But she said a “large amount” of activity was still being performed at other hospitals which they believe they can compete for. She said new work is expected to come from across the West Midlands, into Wales, and down as far as Oxford.

Two of UHB’s consultant hand surgeons have begun to develop a new brachial plexus service with the potential to improve patient care for military and civilian patients suffering major trauma.

Dr Mahendra said patients with such injuries are currently being missed altogether and not offered treatment, or being referred as far away as Derby, Oswestry or Sheffield.

At present, there is little capacity to set up a new service due to existing workloads but a new consultant is due to be taken on which could result in more than 300 additional hand cases a year.

Dr Mahendra added: “Once the brachial plexus service has developed, we estimate that there will be sufficient demand to treat around 24 cases a year at UHB. Approximately half of these cases are likely to be military casualties.”

Existing consultant hand surgeon Dominic Power said expansion of the service would allow him to undertake more complex nerve reconstruction surgery.

“The brachial plexus service is for assessment and reconstruction of complex traumatic nerve injury problems in the neck and upper arm.”

He said the case mix currently being seen included “high energy injuries” such as motorcycle accidents, civilian gunshot and stab injuries, and military blast and gunshot wounds.

“The surgery involves exploration of the damaged nerves and possibly grafting with nerves from the legs, transferring expendable and undamaged nerves, transfer of muscles from the legs and combinations of tendon transfers and joint fusions,” Mr Power added.