In a nerve graft repair, a gap in an injured nerve is bridged by a graft taken from a different nerve.
A nerve graft is generally a portion of a sensory nerve that is sutured into place in the gap created by an injury. Once the graft is in place, it serves as a conduit along which regenerating sensory or motor nerve fibers can grow. Nerves regenerate at the rate of about one inch per month.
When a nerve has been severed, a straightforward surgical repair is sometimes able to reapproximate the cut ends. But other times, the nerve ends cannot be brought together, or can only be brought together under tension. In those cases, a nerve graft may be necessary to join them.
For instance, during repair after a nerve injury, sometimes a neuroma must be excised. Excising the neuroma leaves a gap that may need to be bridged with a nerve graft.
Common donor nerves for graft material include the sural nerve, the superficial radial sensory nerve and the medial antebrachial cutaneous nerve.
During graft repair surgery, the severed nerve is exposed. The donor nerve is also exposed, and an appropriate section is removed.
Using microsurgical technique, the surgeon sutures the graft in place, reconnecting the severed nerve. If the nerve stump is of much larger diameter than the graft material, two or more sections of graft may be sutured into place side-by-side. (For reasons that relate to keeping the graft healthy in the immediate postoperative period, several thinner sections are more effective than one thicker section of graft.)
Make sure you understand the goals of the procedure, its risks and its benefits. It may help to write down your questions as you think of them and to bring the list of questions with you to your appointments.
How long will I stay in the hospital?
Hospital stay is brief. For most patients, this is an outpatient procedure, and patients can expect to go home the same day.
Will I need to take any special medications?
Pain medication may be prescribed as needed to manage any post-procedure pain.
Will I need rehabilitation or physical therapy?
Joints near the nerve graft may be splinted for approximately three weeks after surgery. This minimizes any tension on the healing nerve graft.
Nerves regrow at the rate of about 1mm per day. Therefore the total time to functional recovery will depend significantly on the distance the nerve needs to grow.
Throughout the recovery process, physical therapy will be useful to maintain flexibility and strength.
Will I have any long-term limitations due to nerve graft repair?
You will have numbness in the area originally served by the donor nerve. During the surgical planning stages, your doctor may suggest administering a temporary nerve block to the donor nerve. This is an injection that stops feeling in a nerve for some time, before wearing off on its own. While it is in effect, a nerve block can give you an idea of what the postoperative deficit would be.
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