Nerve Transfer Surgery

What is a Nerve Transfer?

A nerve transfer is a surgical technique where functioning nerves are redirected to take over the role of damaged nerves. In this procedure, a surgeon takes a less critical donor nerve and reroutes it to restore function to a recipient nerve. This procedure allows nerve fibers (axons) to regenerate the damaged nerve and restore the ability to carry movement and sensation signals.

Unlike long nerve grafts, nerve transfers can help restore function more quickly because the transfer is typically closer to the paralyzed muscle.

Nerve Transfer vs. Nerve Graft: What’s the Difference?

While both procedures aim to restore function after nerve injuries, they work differently:

• Nerve Transfer: A nearby, healthy nerve is transferred to a damaged nerve, bypassing the injured area. This technique is often preferred in cases where the original nerve is too damaged for repair, or time is critical for restoring function before the muscle atrophies.
• Nerve Graft: A segment of nerve is taken from another part of the body (called an autograft) or a processed, sterilized donor nerve is used to bridge the gap between the damaged ends of the nerve. Nerve grafts are suitable when the injured nerve retains some capacity to regenerate, but it needs support crossing a gap.

The choice between these techniques depends on factors like the type of injury, location, and the patient’s overall health.

How Does a Surgeon Choose Which Nerve to Transfer?

The selection of a donor nerve in nerve transfer surgery is critical and depends on multiple factors:

• Functionality of the Donor Nerve: Surgeons look for a healthy, redundant, functioning nerve donor that controls less critical movements or sensations. For example, the ulnar nerve might be used in some cases, as it can often be rerouted without severely impacting the patient’s overall hand function.
• Proximity to the Recipient Nerve: The closer donor nerves are to the affected area, the quicker axons can regenerate the damaged nerve. This minimizes recovery time and optimizes results.
• Similarity in muscle function: The donor nerve should ideally supply a muscle with a similar or complementary function, making it easier for the patient to relearn muscle control after the transfer.
• A similar number of axons (nerve fibers): Matching nerves with similar motor and sensory axon composition helps ensure proper function after the repair.
• Similar size: Nerves of similar diameter are easier to connect surgically, reducing the risk of scar tissue or neuroma formation.

Who Can Benefit from Nerve Transfer Surgery?

Nerve transfer surgery is commonly recommended for patients with brachial plexus injuries, spinal cord injuries, and other severe nerve damage. Those with a cervical spinal cord injury or isolated peripheral nerve injury can benefit, especially if traditional repairs or nerve grafts aren’t viable options.

Nerve transfers can also benefit those who have older nerve injuries and may not benefit from other treatments, such as a nerve graft or a tendon transfer.

Examples of patients who may be suitable candidates include:

• Patients with Brachial Plexus Injuries: These complex injuries often lead to paralysis in the shoulder, arm, or hand, making nerve transfers essential for restoring function.
• Patients with Spinal Cord Injuries: For some patients with cervical spinal cord injuries, nerve transfers can help restore key movements like elbow flexion or shoulder stability as they recover.
• Patients with Peripheral Nerve Injuries: Individuals with certain nerve injuries in the arm can benefit from a local nerve transfer to restore function or feeling to a part of the arm or hand. 

Examples of Nerve Transfers in the Upper Extremity

Nerve transfers for treatment of upper extremity nerve injuries include the following:

• Oberlin Transfer: This involves transferring part of the ulnar nerve to the biceps muscle, helping patients regain elbow flexion.
• Double Fascicular Transfer: This procedure combines transfers of both the median nerve and ulnar nerve to different branches, effectively restoring elbow function in cases of severe brachial plexus injuries.
• Spinal Accessory to Suprascapular Nerve Transfer: Often used in cases of shoulder paralysis, this transfer helps stabilize the shoulder by reconnecting the spinal accessory nerve to the suprascapular nerve.
• AIN(anterior interosseous nerve) to Ulnar nerve Transfer: When the ulnar nerve is damaged, the AIN can be transferred to restore function to the small muscles in the hand.

These are just a few examples of how nerve transfers can be used to restore function after certain types of nerve injuries.

Risks and Success Rates

As with any surgery, nerve transfer surgery has risks, including infection, scarring, or the possibility that the nerve fails to regenerate properly. However, many patients report significant improvements, especially when the surgery is performed early enough to prevent irreversible muscle atrophy. Success rates are typically high, but it depends on the type and severity of your nerve injury.

Recovery After Nerve Transfer Surgery

Recovery from nerve transfer surgery requires patience and commitment. The process is gradual, as it takes time for axons to regenerate and the nerve to regain its ability to carry movement and sensation signals.

Physical therapy plays a crucial role in helping patients regain strength and relearn movements. A therapist examines a patient’s shoulder as he recovers from a nerve transfer surgery, ensuring proper healing and guiding rehabilitation.

Patients recovering from nerve transfer surgery often participate in specialized rehab programs. The success of the surgery depends heavily on this rehabilitation process, allowing patients to maximize their recovery as the nerve regains its function.

Explore Your Treatment Options

If you’re considering nerve transfer surgery or if you’re seeking advanced care for nerve injuries, Georgia Hand, Shoulder & Elbow offers a range of treatments to help restore your quality of life. Our experienced team of specialists in Marietta and Atlanta, GA, provides personalized care for each patient’s unique situation. Contact us today to learn how nerve transfers can help restore your mobility and function!