Peripheral nerve reconstruction
If a nerve is partially or completely transected, repair is indicated using microsurgical techniques in order to preserve as much function as possible. Often, direct repair is not possible. Instead, nerve reconstruction using microsurgical instruments and techniques may include:
- Nerve conduits (tubes to bridge small nerve, < 1-1.5 cm defects)
- Nerve allograft (processed human cadaver nerve to bridge small-to intermediate large nerve gaps; 1-5 cm)
- Nerve autografts (used from the patient him/herself from other, less critical nerves for 1>5 cm gap reconstruction, especially when a critical nerve is reconstructed)
An important consideration is that the repair should be done immediately (same day). If not possible, every attempt should be made to perform nerve repair within 3 weeks since after that period, irreversible functional loss of nerve and innervated muscle function can be occur. Once the nerve is reconstructed, it recovers at approximately a half to one millimeter per day, so bear in mind that your response to the surgery may be delayed, as you recover your function little by little. Sometimes, despite our best efforts, a functional outcome may not occur and secondary procedures such as tendon transfers and/or nerve transfers may be indicated.
You should also know:
Who is a Candidate for Nerve Reconstruction?
Anybody with acute or delayed nerve damage that requires restoration of original nerve function. Some examples include:
- Hand/finger injuries with sharp objects (usually knife) resulting in scar, pain and or numbness distal to the injury site
- Traumatic or surgical injuries of any type involving the upper or lower extremity resulting in acute or delayed loss of the nerve function
- Nerve deficit following nerve tumor removal
What Can I Expect During a Nerve Reconstruction?
- Under general anesthesia an incision is made over damaged nerve in your skin. If operating on an extremity, a tourniquet is used (as long as there are no contraindications) which allows a bloodless field and decreased blood loss.
- Once the nerve is accessed, damaged nerve ends are trimmed and nerve reconstruction, using one of the aforementioned methods is done.
- The wound is then closed in anatomical layers and the incision covered with a sterile dressing.