Nerve Transfer in Los Angeles, CA
What is a Nerve Transfer?
In a Nerve Transfer procedure, a healthy and working motor nerve is transferred from an expendable muscle and delivered to the injured target nerve to turn back on a more important muscle. Donor sites may include an extra nerve controlling shoulder shrug, elbow extension, wrist flexion, or the rib muscles.
When is a Nerve Transfer needed?
In avulsion-type injuries, the nerve is directly ripped off its source in the spinal cord. Unlike rupture-type injuries, there aren’t two free nerve ends that can be bridged with a graft. Only one free nerve end is present and visible, namely the target nerve end that runs into the muscle. In this situation, the only reliable method for nerve reconstruction is with a Nerve Transfer.
What conditions can be treated with a Nerve Transfer?
What are the benefits of using a nerve transfer over nerve grafting or repair?
Nerve transfer has the advantage over primary nerve repair and long nerve grafting of shortening the length that the nerve must regenerate by bringing the donor nerve closer to the target muscle. Compared to a tendon transfer, successful nerve transfer in the reactivated muscle returns function that is similar to its original level. Recovery is faster (usually around 10 days in a sling versus 6-12 weeks in a brace for a nerve transfer versus graft on an elbow extension) and reeducation and reactivation of the muscle returns more quickly.
In tendon transfer, where muscles are re-sited from another area of the body to the injury site, those muscles are designed for another function. In contrast, nerve transfers allow the direct reanimation of the paralyzed muscle itself. Additionally, nerve transfers can re-animate more than one muscle at a time, and don’t run into the problem of tendon tensioning after a tendon transfer.
Nerve Transfer Procedure
This operation is analogous to what an electrician sometimes does when the power is shut off to an important part of the house. If the blue wire that is feeding the air conditioning unit (important muscle, i.e. biceps) is corroded directly off its energy supply (spinal cord), we can take the yellow wire that is feeding an unimportant closet light (expendable muscle, i.e. shoulder shrug) and redirect it to the blue wire further down beyond the area of corrosion. It is what electricians call a “bypass.”
Does a Nerve Transfer Require Anesthesia?
Nerve Transfer surgery is performed under general anesthesia.
How Long Does a Nerve Transfer Procedure Take?
A nerve transfer procedure can take several hours.
Recovering after a Nerve Transfer
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 on Tylenol, Motrin, and a short course of narcotics. If rib (intercostal) nerves are used, patients may be admitted overnight in the Intensive Care Unit as a precaution to monitor their breathing. 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. As compared to a Nerve Graft, a Nerve Transfer provides an “active” form of reconstruction by bypassing a substantial area of nerve injury with a healthy, motor nerve that can deliver the nerve cells closer to the nerve/muscle target. By cutting down on the distance of the nerve to its target muscle, this can significantly shorten the recovery time.
Will I have scarring after getting a nerve transfer?
Dr. Seruya will make an incision above the affected muscle. The incision needs to be long enough to gain access to both the expendable muscle and its motor nerve. Any time an incision is made into human skin, the healing process creates a scar. That is inevitable. Our patients at Los Angeles Nerve Institute feel the tradeoff of having a visible scar in exchange for regaining movement and function in the injured muscle is well worth it.
How can I prepare for a Nerve Transfer procedure?
A specialist performs a thorough consultation and examination to determine the merit of nerve transfer. Patients have very little to do to prepare for their procedure outside of making sure that they understand the risks and goals associated with this procedure. Questions should be written down and brought to presurgical appointments. It is also important to provide the surgeon with a list of all medications and supplements that are currently being taken. In some cases, it is necessary to adjust medications or dosing.
Is a Nerve Transfer procedure painful?
Nerve transfer procedures are performed using general anesthesia. Patients feel no pain and have no recollection of their procedure once they are awake after surgery. The doctor may prescribe pain medication to take as directed for a few days. However, comfort is often surprisingly better than patients expect.
Who is the ideal candidate for a nerve transfer?
Nerve transfer surgery may be recommended to repair severe nerve damage. When considering surgery, the surgeon also evaluates factors such as:
- Patient age
- General health
- The severity of symptoms
- The root cause of nerve damage and its severity
- The severity of nerve damage
What factors would preclude a person from being able to have a nerve transfer?
How common are nerve transfers?
Nerve transfer surgery is still relatively new, but it is proving to have excellent outcomes and return to strength in the damaged muscle and/or limb.
There is increasing research showing outcomes from nerve transfer are better than with both nerve grafting and tendon transfers, especially when it comes to functionality in the repaired muscle.
Because these are not typical surgeries, that makes it even more important to trust this procedure to a specialist in peripheral nerve surgery, such as Dr. Seruya.
What is the success rate of Nerve Transfer procedures?
Nerve transfer surgery can be highly successful in the right circumstances. Studies indicate that success rates are higher when the transfer is performed within months of the injury. Over time, without sufficient innervation, the affected muscle may degrade. In addition to the timing of the nerve transfer procedure, adequate pre-and post-operative rehabilitation involving physical or occupational therapy can help promote an optimal outcome.
How soon after a Nerve Transfer procedure can I resume my daily activities?
Patients may begin a physical or occupational therapy program shortly after their procedure. However, normal activities may be somewhat limited due to the bulky dressing that is worn for approximately three weeks. Full recovery from the nerve transfer procedure can take between a few months and 24 months. As the muscle begins “firing” again, more activities can be resumed. The timing of recovery varies depending on several factors. We follow patients closely to ensure proper care is provided throughout the entire process.
What are the risks involved with nerve transfer surgery?
These are major surgeries, so they entail the same risks involved with any surgery, namely reaction to anesthesia, excessive bleeding, poor incision healing, and the like. These are rare in these procedures with Dr. Seruya.The real “risk” involved is waiting to have this procedure. The best results occur when the injury occurred within just a few months. The longer the impacted muscle and nerves involved with the damage are left unrepaired, the lower the chance of success with this surgery.