Reconstruction
Peripheral Nerve Reconstruction
A nerve is not a wire that can simply be reconnected. It is a bundle of thousands of fibres, each of which has to regrow from the point of injury all the way to its destination - at roughly a millimetre a day.
That biology governs everything about nerve reconstruction: why timing matters, why tension is unacceptable, and why the muscles a nerve supplies set a practical deadline for restoring their supply.
What the problem looks like
- Numbness or weakness that has not recovered in the expected timeframe
- A nerve known to have been divided
- A painful, tender spot at a scar with electric sensations
- Nerve symptoms that persist after previous decompression surgery
- Muscle wasting following an injury
Loading anatomy
Principles
How this kind of reconstruction is approached
- 01
Repair without tension
Nerve ends brought together under tension do not do well. Where a gap exists it is bridged, not pulled closed - that is the whole reason grafting exists.
- 02
Bridge the gap
A nerve graft provides a scaffold along which regenerating fibres can travel. The graft is usually taken from a nerve whose loss is well tolerated.
- 03
Borrow a nearby function
A nerve transfer redirects a working nerve branch that can be spared to restore a more important function. Because the transfer is done close to the target muscle, recovery starts sooner.
- 04
Free the nerve from scar
A nerve encased in scar tissue can be compressed and tethered even when it was never divided. Releasing it is sometimes the whole operation.
- 05
Time is muscle
Muscles that stay without a nerve supply for long enough lose the ability to be reinnervated. This is why nerve problems are assessed early, and why the timeline is discussed frankly.
Clinical detail
Assessment distinguishes lesions likely to recover spontaneously from those that will not, using serial clinical examination, the advancing Tinel sign and electrodiagnostic studies over time.
Reconstructive options include neurolysis, direct coaptation, autograft, conduit or processed allograft for selected gaps, and distal nerve transfer where the time to reinnervation would otherwise exceed the viable window.
Painful neuroma management is planned according to whether the involved nerve has a distal target available for reconstruction.
Related conditions
Peripheral Nerve Injuries
Damage to the nerves that carry signals between the brain and the hand, causing numbness, weakness or pain in the territory that nerve supplies.
Carpal Tunnel Syndrome
Pressure on the median nerve where it passes through a narrow tunnel at the wrist, which can cause numbness, tingling and weakness in the hand.
Complex Hand Trauma
Severe injuries that damage more than one tissue system at once - bone, tendon, nerve, blood vessel and skin together.
All reconstruction categories · Revision & secondary surgery
Discuss peripheral nerve reconstruction
Consultations begin with understanding your symptoms, what you can no longer do comfortably, and what has already been tried.