Nerve Transfer Surgery
Nerve transfer surgeon Sydney
Nerve transfer surgery is a procedure that can be used in patients who have injuries to certain nerves of the arm or leg, or even to the spinal cord. It can help to restore function in muscles that have been paralyzed due to a lack of nerve supply. Nerve transfer surgery is a relatively new procedure, but it has quickly been gaining popularity as research has shown excellent outcomes from this procedure in many patients.
What is nerve transfer surgery? How does it work? Who would be a candidate for this procedure, and why might you choose it over other options?
How does nerve transfer surgery work?
For nerve transfer surgery, the surgeon takes a branch of a functioning nerve, called the donor nerve. This branch of the nerve is rerouted, and connected to the area that experienced nerve damage (called the recipient nerve).
Axons (long projections) from the donor nerve will grow through the recipient nerve, and will begin functioning to provide motor control and/or sensation that had been lost because of nerve damage. The recipient nerve serves to help guide the donor neurons to get their axons to the right target. Once they’re there, the donor neurons will form electrical connections with the muscle cells and will become capable of activating the muscle.
Besides restoring muscle function, nerve transfer surgery can also be used to restore sensory function to a part of the body that has lost it. This can address areas of numbness that can occur after peripheral nerve damage. Nerve cells cannot change function; a given nerve cell is either a motor neuron or a sensory neuron, and it can’t switch. However, almost all nerves contain both motor and sensory branches. A surgeon can use motor branches of the donor nerve to restore motor function, and sensory branches to restore sensory function.
This type of surgery is highly technical, and not all surgeons are trained to perform it. Dr. Sungaran has specialised training in the techniques of microsurgery, and so he has the skills and experience necessary to get the best possible outcomes from nerve transfer surgery.
What are the alternatives to nerve transfer surgery?
There are also other ways of restoring innervation to a muscle after nerve damage. One option is a nerve graft. This is similar in some ways to nerve transfer surgery. However, with nerve transfer, one end of the nerve remains in its original location, while the other end is reconnected to the damaged muscle. With a nerve graft, a piece of a nerve is removed entirely from its original location and is used for repair of the damaged piece of nerve.
Another option may be direct nerve repair. In this procedure, the surgeon attempts to reconnect the two ends of a damaged nerve. This may be possible in certain cases, but it isn’t an option in every case. Whether direct nerve repair is possible depends on factors such as how the nerve was damaged and how long has passed since that time.
In some cases, another possibility is a tendon transfer. Instead of just transferring a nerve, this type of surgery takes a part of a muscle, along with its associated tendon and nerve, and moves it from one place to another. This surgery can be used after many different types of injuries. For patients with peripheral nerve injuries, it can be an option in some cases.
Who might benefit from nerve transfer surgery?
In order for nerve transfer surgery to be a good option, there needs to be a working nerve available, which is located fairly close to the damaged one. Patients with certain types of peripheral nerve injuries may be good candidates, especially if the nerve injury is located higher up on the arm or the leg. People with brachial plexus injuries, for example, often benefit from nerve transfer surgery. It can also be used on some patients with spinal cord injuries. In this case, the donor nerve is a nerve originating from the part of the spinal cord above the injury, and the recipient nerve is one that has lost its function because it originates below the injury.
Nerve transfer surgery tends to offer a quicker recovery of function than other options, and the surgical recovery period is also easier. In addition, research indicates that the overall outcomes may be better from nerve transfer surgery, when it’s used for the right patients.
What are the downsides of nerve transfer surgery?
Although nerve transfer surgery provides excellent results for many patients, there are certain factors that it’s important to be aware of. One is that there is generally some loss of function in the muscles served by the donor nerve. When a piece of a nerve is taken to be used as the donor nerve for nerve transfer surgery, this means that its original target will now lose some innervation. Donor nerves are carefully selected so that important functions will not be interrupted, and the gain of function in the recipient nerves is usually considered worth the sacrifice of some of the function of the donor nerve. However, it’s important to be aware that this tradeoff is being made.
In addition, after a muscle has been deprived of its nerve (because that nerve has been transferred to a different muscle), that muscle will atrophy, meaning that it experiences a loss of muscle tissue. A muscle that has undergone atrophy will no longer be functional, and we won’t be able to use it to try a tendon transfer procedure later. However, because nerve transfer has shown better results overall and has an easier recovery than tendon transfer, this tradeoff is often worth it.
Another potential issue is known as co-contraction. During nerve transfer surgery, we are dividing a nerve into two parts, and the nervous system is used to activating both parts together. Because of this, after a branch of a nerve is donated, it may be impossible at first to activate the two parts independently. For example, some patients may find that they can only bend their elbow while taking a deep breath.
Co-contraction generally isn’t a permanent issue; the nervous system is very flexible, and over time, it learns to activate the two muscles independently. However, the process can be a bit uncomfortable for patients, especially at first. You should be prepared to invest time and effort in physical therapy after your nerve transfer surgery, in order to regain good function.
Nerve transfer surgeon Sydney
If you’ve experienced a peripheral nerve injury or spinal cord injury that has impacted your ability to function in your daily life, then nerve transfer surgery might be an option for you. To learn more and find out whether you’d be a good candidate for this cutting-edge procedure, you’ll need to visit with a qualified surgeon to discuss the particulars of your situation.
Dr. Sungaran is highly trained in the field of microsurgery, and is recognised as an expert in nerve transfer surgery. In fact, he has presented research on nerve transfer surgery at the Australian Orthopaedic Association conference. If you’re in Sydney or the surrounding area, we invite you to schedule a consultation with Dr. Sungaran in one of our two convenient locations. Some of our patients live farther afield, and travel here in order to consult a recognised expert in nerve transfer surgery. To book your appointment, please get in touch with our front desk staff.
