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?
Nerve Transfer Procedure
Nerve Transfer surgery is performed under general anesthesia and can last several hours.
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.”
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.
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 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.