From the Guidelines
Peripheral nerve transfer is a surgical procedure where a functioning nerve is redirected to restore function to a damaged or non-functioning nerve, and it involves taking a healthy nerve with less critical function and connecting it to a more important but injured nerve to restore movement or sensation. This technique is particularly valuable for treating injuries where the original nerve cannot be repaired directly, such as brachial plexus injuries, facial paralysis, or certain types of limb trauma. The success of peripheral nerve transfer depends on factors including patient age, time since injury, condition of target muscles, and proximity of the donor nerve to the target 1.
Key Considerations
- The procedure involves identifying a donor nerve that has similar function to the recipient nerve, disconnecting it partially or completely from its original target, and then connecting it to the injured nerve.
- Recovery typically takes months as nerve regeneration occurs slowly at a rate of approximately 1-3 mm per day.
- Physical therapy is essential following surgery to maintain muscle condition and retrain the brain to interpret new nerve pathways.
- Patient preparation and asepsis should be similar to that followed for the neuraxial procedure, and the dose of pre-procedural sedation, if used, may need to be reduced to avoid any respiratory compromise 1.
Benefits and Risks
- Peripheral nerve transfer can restore movement or sensation to damaged or non-functioning nerves, improving quality of life and reducing morbidity.
- The risks associated with the procedure include infection, nerve damage, and adverse reactions to anesthesia.
- The use of peripheral nerve blocks, such as fascia iliaca compartment block, has been shown to be effective in managing acute pain associated with traumatic fractures in elderly patients, reducing the use of opioids and length of hospital stay 1.
Recent Evidence
- A systematic review of 27 RCTs with 2478 cases assessed the use of fascia iliaca compartment block as an analgesic strategy for perioperative pain management in geriatric patients with hip fractures, and showed that this technique is safe, reliable, and able to provide adequate pain relief 1.
- The AnAnkle Trial, a randomized blinded trial, reported that peripheral nerve block anesthesia decreased the postoperative pain intensity in primary ankle fracture surgery compared with spinal anesthesia, and consequently the consumption of opioids 1.
From the Research
Definition and Purpose of Peripheral Nerve Transfer
- Peripheral nerve transfer is a surgical technique that involves using a working, functional nerve with an expendable or duplicated function as a donor to supply axons and restore function to an injured recipient nerve 2.
- The primary goal of peripheral nerve transfer is to restore motor and sensory function in patients with peripheral nerve injuries, which can result in devastating numbness and paralysis 3.
Types and Applications of Peripheral Nerve Transfer
- Nerve transfers were originally popularized for the restoration of motor function in patients with peripheral nerve injuries, but novel uses have been described, including nerve transfers for sensory reinnervation, spinal cord injury, and stroke patients 2.
- Distal nerve transfers are becoming a more common strategy in the repair of nerve deficits, as they can restore function in months, compared to traditional nerve grafts, which can take over a year 3.
- Nerve transfers can be used to restore specific functions, such as shoulder abduction and external rotation, elbow flexion, and ulnar intrinsic function, by transferring healthy donor nerves to denervated targets 4.
Benefits and Advantages of Peripheral Nerve Transfer
- Nerve transfers offer the potential for superior functional recovery in severe nerve injuries, especially in cases where traditional grafting is not possible or has a poor prognosis 4.
- A carefully devised nerve transfer can restore function with minimal detectable deficits at the donor site, and patient reeducation can allow for good return of strength and function after nerve transfer 3.
- Nerve transfers can be used in combination with other therapeutic approaches, such as cell-based therapies and biomaterials, to enhance functional recovery and overcome limitations 5, 6.