Who is a candidate for a Nerve Graft?
In rupture-type injuries or when a nerve is cut by trauma, the nerve snaps and leaves two free ends that are no longer talking to each other. As a result, electrical signals are not crossing the nerve and telling the muscle to turn on and move. In this situation, a Nerve Graft may be a useful treatment option.
What is a Nerve Graft?
This procedure relies on cutting out the scar tissue, called a neuroma, that fills the gap between the two free ends. After measuring the length of the gap, Nerve Graft is harvested to bridge the defect. Donor sites include the back of the calf, front of the forearm, or back of the wrist. A sensory nerve is selected from one of these areas, one that relays feeling from a non-critical area of the body. Routinely, the graft is cut into multiple strands and stacked on top of each other to match the size of the free nerve ends, thus producing a “cable”. A cable graft relies on the nerve cells at point A (the origin) to walk across the graft and meet its partner at point B (target nerve with its muscle). A useful analogy would be building a bridge (nerve graft) across two islands. Island A (nerve origin) is populated and Island B (nerve and muscle target) is empty. Even though the bridge (graft) is constructed, we do not expect any activity on Island B (muscle function) until the cars (nerve cells) get across the bridge (graft).
How long is the recovery for a Nerve Graft?
Nerve Graft surgery is performed under general anesthesia and can last several hours. After surgery, the operative area is wrapped in a bulky dressing to protect the nerve reconstruction against motion. For most procedures, patients may only need an overnight hospital stay and are discharged to home the following morning on Tylenol, Motrin, and a short course of narcotics. Three weeks after surgery, patients may take off their bulky dressing. Patients will be followed closely by occupational therapists, who will use electrical stimulation to gently help the nerves turn back on. The movement of nerve cells across the graft occurs at 1 mm per day, thus it can take 6-12 months for the injured nerve to recover and turn on its target muscle. The areas farthest from the nerve source in the spinal cord, take the longest to recover whereas the areas closest to the spinal cord recover first.
Which conditions can be treated with a Nerve Graft?
Nerve Graft procedures are useful in treating some forms of;
- Brachial Plexus Palsy
- Facial Paralysis
- some forms of foot drop from Peroneal Nerve Entrapment