A nerve transfer is a procedure in which one end of a healthy nerve is transferred to the site of an injured nerve, with the goal of restoring movement or sensation.
A nerve transfer is performed when a motor or sensory nerve has sustained severe damage that prevents it from communicating with the spinal cord.
An injury that destroys a nerve’s connection to the spinal cord means that the nerve will be capable of no useful function: A sensory nerve will not be able to transmit any sensory information to the brain, resulting in numbness. A motor nerve will not be able to receive and execute any movement instructions from the brain, resulting in paralysis.
A nerve transfer, in which a healthy nerve “donates” its connection to the spinal cord, can restore either motor or sensory function. The restoration may come at the cost of movement or sensation in the location originally served by the donor nerve. Therefore, donor nerves are chosen carefully: In some cases, their function is considered less useful than the function to be regained. In other cases, the function of the donor nerve is redundant—that is, more than one nerve supplies the function of the donor nerve. And in some cases, function need not be sacrificed at all, as only certain fascicles of the donor nerve are divided and transferred.
Nerve transfers are performed using the tools and techniques of microsurgery.
First the surgeon makes a skin incision and exposes both the nerve to be transferred and the injured nerve. Using electrical stimulation and monitoring, the nerves are tested for function and health. If only certain fascicles of the donor nerve are to be divided and transferred, individual fascicles are tested.
Leaving intact the donor nerve’s connection with the spinal cord, the surgeon mobilizes a distal portion of donor nerve—a section long enough to reach the injured nerve.
The mobilized section of donor nerve is moved from its original location to the location of the injured nerve. The end of the donor nerve is coapted to the injured nerve. Now nerve fibers are connected, and the nerve with a healthy connection to the spinal cord can grow down through the conduit provided by the injured nerve.
The “conduit” is important, as it provides all the complex conditions that support nerve growth. It also makes all the appropriate connections to the right sensory or motor targets. Growth of new nerve occurs at the rate of approximately one inch per month.
The incisions are then closed.
Specific details—incision sites, scarring, postoperative deficit and speed of recovery—vary by case and type of nerve transfer. Speak with your surgeon about your particular case.
Make sure you understand the goals of this procedure, as well as its risks. You may wish to write down your questions as you think of them and bring the list to your appointments.
Tell your surgeon about any medications you take, and ask if your medication schedule should be adjusted in any way for surgery.
How long will I stay in the hospital?
Nerve transfers are typically performed as outpatient procedures.
Will I need to take any special medications?
A few days of pain medication may be prescribed following the procedure to manage any discomfort.
Will I need rehabilitation or physical therapy?
Physical therapy may be important both before and after surgery, but its role will be determined by your surgeon on a case-by-case basis.
Prior to surgery, physical therapy can help maintain a muscle’s range of motion.
Following surgery, physical therapy may be necessary to “re-train” the body and mind to use nerve input from a new source.
Will I have any long-term limitations due to nerve transfer?
One possible limitation is a motor or sensory deficit at the original site of the donor nerve. Speak with your surgeon about the likelihood of such a deficit and its possible extent. Even when a deficit is certain, most people considering this type of surgery find the trade-off to be greatly to their benefit.
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