Nerve Transfers

Wong, Anselm; Pianta, T.J.; Mastella, D.

doi:10.1016/j.hcl.2012.08.007

Cited by 12 publications

(5 citation statements)

References 46 publications

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“…However, in the ensuing decades particularly after the advent of microsurgery in the 1960s nerve autografting achieved success and became the preferred reconstructive method. It was not until the 1970s and 1980s that interest in nerve transfers was revived [52]. …”

Section: Surgical Alternatives To Nerve Repair: Nerve Transfers Anmentioning

confidence: 99%

“…In most cases there is only one neurorrhaphy site; with nerve grafts, there are two. In addition, nerve transfers minimize the distance over which a nerve has to regenerate because it is closer to the target organ and is more specific [52]. Pure motor donors are joined to motor nerves and sensory donors to sensory nerves, optimizing regeneration potential.…”

Section: Surgical Alternatives To Nerve Repair: Nerve Transfers Anmentioning

confidence: 99%

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Peripheral Nerve Reconstruction after Injury: A Review of Clinical and Experimental Therapies

Grinsell

Keating

2014

BioMed Research International

793

694

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Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain good to excellent motor or sensory function and current surgical techniques are similar to those described by Sunderland more than 60 years ago. Our increasing knowledge about nerve physiology and regeneration far outweighs our surgical abilities to reconstruct damaged nerves and successfully regenerate motor and sensory function. It is technically possible to reconstruct nerves at the fascicular level but not at the level of individual axons. Recent surgical options including nerve transfers demonstrate promise in improving outcomes for proximal nerve injuries and experimental molecular and bioengineering strategies are being developed to overcome biological roadblocks limiting patient recovery.

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Section: Surgical Alternatives To Nerve Repair: Nerve Transfers Anmentioning

confidence: 99%

Section: Surgical Alternatives To Nerve Repair: Nerve Transfers Anmentioning

confidence: 99%

Peripheral Nerve Reconstruction after Injury: A Review of Clinical and Experimental Therapies

Grinsell

Keating

2014

BioMed Research International

793

694

View full text Add to dashboard Cite

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“…Thus, the authors strongly recommend seeing the patients regularly together within a multidisciplinary team to be able to discuss if recovery goes as expected or if any additional medical interventions are necessary. However, especially after severe injuries such as C8 and Th1 nerve root avulsions, realistic outcomes might not include full recovery of extremity function 3,30 . In these cases, the clinical team needs to communicate this to the patient as soon as a realistic prognosis can be stated (approximately one year after the nerve transfers).…”

mentioning

confidence: 99%

Structured Motor Rehabilitation After Selective Nerve Transfers

Sturma¹,

Hruby²,

Farina³

2019

JoVE

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After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on the successful re-innervation of the targets in the periphery and on the motor re-learning process entailing cortical plasticity. While there is an increasing number of methods to improve rehabilitation, their routine implementation in a clinical setting remains a challenge due to their complexity and long duration. Therefore, recommendations for rehabilitation strategies are presented with the aim of guiding medical doctors and therapists through the long-lasting rehabilitation process and providing step-by-step instructions for supporting motor re-learning. Directly after nerve transfer surgery, no motor function is present, and therapy should focus on promoting activity in the sensory-motor cortex areas of the paralyzed body part. After about two to six months (depending on the severity and modality of injury, the distance of nerve regeneration and many other factors), the first motor activity can be detected via electromyography (EMG). Within this phase of rehabilitation, multimodal feedback is used to re-learn the motor function. This is especially critical after nerve transfers, as muscle activation patterns change due to the altered neural connection. Finally, muscle strength should be sufficient to overcome gravity/resistance of antagonistic muscles and joint stiffness, and more functional tasks can be implemented in rehabilitation. Video Link The video component of this article can be found at https://www.jove.com/video/59840/ 9 , movements associated with ulnar nerve activity (such as hand closing or ulnar abduction of the wrist) are used for the activation of the biceps muscle directly after re-innervation. However, exercises based on this approach can be performed in other body parts as well. If special considerations are necessary to implement this in other body parts (e.g., the lower extremity), this is pointed out within the protocol. Independent from the body part affected, therapy sessions should not exceed 30 min as muscles become easily fatigued shortly after reinnervation 8 and successful training requires a patient's full commitment and focus.

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“…Criteria for the choice of nerve graft donor as well as benchmarks for the assessment of reinnervation of denervated territory are described previously. [45] Our patient recovered full motor function in his quadriceps. It is interesting to note that though a sensory nerve was used for the repair; the patient regained full function.…”

Section: Discussionmentioning

confidence: 80%

“…In general, it is recommended that mixed sensory-motor nerves are used for grafting or that the donor type is matched to the injured nerve. [56] The sural nerve is a relatively expendable nerve, and its successful use, in this case, is encouraging given the need for a large-diameter nerve.…”

Section: Discussionmentioning

confidence: 93%

Complete Femoral Nerve Transection with Sural Nerve Cable Graft in a 21-Month-Old Child

Pillutla

Nix

Elberson

et al. 2019

Journal of Neurosciences in Rural Practice

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Severe peripheral nerve injury occasionally requires urgent nerve grafting especially with significant separation of the proximal and distal ends of the injured nerve. Proper reinnervation to provide continued sensory and motor function is essential especially in the pediatric population. These patients would suffer lifelong disability without correction, yet have significantly improved regenerative capacity with prompt and effective management, making nerve grafts an ideal choice for complete nerve transection. This case report describes the successful sural nerve cable graft reinnervation of a transected femoral nerve in a 21-month-old male. This procedure was made difficult by severe trauma to the surrounding area with laceration of the femoral artery, significant separation of the femoral nerve ends, and the compact anatomy of such a young patient.

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Nerve Transfers

Cited by 12 publications

References 46 publications

Peripheral Nerve Reconstruction after Injury: A Review of Clinical and Experimental Therapies

Peripheral Nerve Reconstruction after Injury: A Review of Clinical and Experimental Therapies

Structured Motor Rehabilitation After Selective Nerve Transfers

Complete Femoral Nerve Transection with Sural Nerve Cable Graft in a 21-Month-Old Child

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