Permanent nerve damage causes a person to lose sensation and use of the affected area. Nerve transfers are a technique that is used by John R. Barbour, MD, FACS, to repair the damaged nerve and restore function. As a triple board-certified plastic and reconstructive surgeon and fellowship trained hand and peripheral nerve specialist, Dr. Barbour has the expertise to successfully perform nerve transfers for the residents of the Washington, DC, area, including Fairfax, Arlington, Alexandria and surrounding communities in Virginia.
Extremity Nerve Transfers
A nerve transfer is a surgical technique that may be used when a patient has a nerve injury resulting in complete loss of muscle function or sensation. Nerve transfers involve taking nerves with less important roles — or branches of a nerve that perform redundant functions to other nerves — and “transferring” them to restore function in a more crucial nerve that has been severely damaged. Nerve transfers can be performed for injury to either nerves that control motor function or nerves that allow for sensation. Peripheral nerve surgeons will use functioning nerves that are close to the target muscle or sensory area, and these nerves are “transferred” (or divided and connected) to the injured nerve that no longer functions. The nerve that has been transferred now supplies that function. Motor nerves are used to re-innervate muscles and regain movement, and sensory nerves are transferred to regain sensibility in very important areas. This technique provides a nearby source of nerve for faster recovery.
Motor Nerve Transfers
Because of the need to reconnect the nerve to the muscle to prevent permanent paralysis, nerve transfers for motor nerve injuries should ideally be performed within the first 6 months from the initial injury. The decision to perform this procedure is made after adequate time is allowed for the muscles to improve on their own as well as in combination with EMG test results. Specially trained hand therapists are needed to help re-train the muscles to work well after surgery, and sometimes the procedure may take several months before the improvement is obvious.
An example of a reliable nerve transfer is the one used to restore the ability to flex the elbow. This nerve transfer uses small branches of the large ulnar and median nerves to plug into the nerve branches to the muscles that bend the elbow (called the biceps and brachialis) much closer to these muscle bellies. Elbow flexion is usually restored over time as the nerve is given time to regenerate into the paralyzed muscle.