Who is a candidate for a Nerve Transfer?
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 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. 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.”
How long is the recovery for a Nerve Transfer?
Nerve Transfer 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 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.
Which conditions can be treated with a Nerve Transfer?
Nerve Transfer procedures are useful in treating;
- Acute Flaccid Myelitis
- Brachial Plexus Palsy
- Facial Paralysis
- some forms of foot drop from Peroneal Nerve Entrapment
- Phrenic Nerve Paralysis