Nerve transfer involves moving working nerve branches from adjacent uninjured nerves to reconnect to an injured nerve close to its connection to muscle to restore function. Nerve transfers are able to restore function to muscles by placing the recovering nerve endings closer to the target muscle area before irreversible damage occurs.
Nerve transfers in many cases have replaced nerve grafting. Sensation can also be restored with nerve transfers of working sensory nerves to nonfunctioning sensory nerves in a related procedure.
When the nerve recovers, physical therapy is initiated to maximize the functional gains. Physical therapy will concentrate on retraining better function as the sensation returns. Physical therapy helps maintain flexibility and motion in the joints and muscles.
Nerve transfer procedure takes a donor nerve from another location in the patient’s body and connect it to the site of the damaged nerve to restore its function. The surgeon separates out the bundles of nerve fibers (fascicles) that deliver the important information. Nerve transfer reconstruction surgery offers advantages including the potential for a faster reconnection of the nerve tissue and muscles.
In addition to its use in brachial plexus injury, nerve transfers can be an effective treatment for other complex injuries to the peripheral nerves, especially nerve problems associated with fractures and dislocations, nerve lacerations, nerve tumors, and injuries from projectiles.
Surgeons refer to various types of nerve transfers based on the location of the donor nerve.
Intraplexal nerve transfers are done within the brachial plexus. One example is the intraplexal nerve transfer of the ulnar nerve to the biceps branch of the musculocutaneous nerve to help restore elbow function.
Extraplexal nerve transfers connects a donor nerve from a site that is outside the brachial plexus. Patients with injuries to multiple levels in the brachial plexus may require an extraplexal transfer, such as one involving the intercostal nerve in the rib cage to the biceps.
Distal nerve transfer utilizes nerve tissue below the elbow that can be moved to reinnervate the ulnar nerve and help restore function to the hand.
Depending on the nature of the injury, the surgeon may perform nerve transfers in combination with other nerve reconstruction procedures. Nerve transfers may also be called neurotization, heterotopic nerve suture, and nerve crossing.
Periodic monitoring and electrodiagnostic testing is important to ensure that recovery is occurring.
Free muscle transplantation is the transfer of a skeletal muscle and its own blood supply from one location in the body to another. In brachial plexus injury, the gracilis muscle (a long muscle on the inside of the thigh) that helps flex the knee and turn the hip inward is transplanted to the arm to restore the patient’s ability to bend the elbow and move the fingers.
Free muscle transplant may help restore certain types of function months or even years after the initial nerve injury.
Pedicle muscle transfer procedure moves only the muscle but the blood vessels and nerves to the muscles are left attached.
Tendon transfer takes a tendon from one part of the body and moves it to another part of the body. Most tendon transfers do not require microsurgery at the microvascular level.
Patients whose affected arm has healed in an unnatural position, may benefit from fusion, in which the bones are realigned into a more natural position and pins and other instrumentation are placed to secure the bone during healing.