Functional restoration after peripheral nerve lesion: Nerve repair strategies, tendon transfer and free muscle transfer

Abstract

Traumatic peripheral nerve injuries are a major and frequent clinical problem, and surgical repair has challenges. For the achievement of optimal functional preservation and restoration of function, an early diagnosis with appropriate therapy is critical. In the European Union, over 300,000 cases of peripheral nerve injuries are reported annually. In addition to trauma, tumour infiltration or neuroma resection can result in severe peripheral nerve damage and even complete functional deficit of an affected extremity. While repair of the brachial plexus and long defect injuries has significantly improved over the past few decades, a number of challenges remain. The current gold standard in peripheral nerve surgical repair is the use of a tension-free end-to-end suture. When there is an extensive loss of nerve tissue with a resulting nerve gap, tension-free end-to-end-suture is not possible. In these cases, autologous nerve transplantation is performed. Updated technology including new microsurgical equipment and materials has expanded surgical options to reconstruct these highly complex nerve injuries. These surgical options include neurolysis, nerve grafting, neurotisation, tendon transfer and functional muscle transfer. Here, several surgical techniques will be presented that have consistently provided good results in our patients who require surgical reconstruction after nerve injury.