Nerve Graft and Nerve Transfer

Basic Principles

Only certain nerves are capable of being harvested. For nerves for the finger, because only thin and comparatively short nerves are required for nerve transplant, the cutaneous nerve of the forearm and the posterior interosseous nerve can be used.

In cases requiring reconstruction using long or thick nerves, the sural nerve can be used. The sural nerve can be folded up and used as a cable graft for reconstructing thick nerves. In the distal 2/3 of the lower leg, the sural nerve runs above the calf, and apart from muscle perforators of the posterior tibial artery, also obtains blood flow from the peroneal artery fascial branch. Therefore one advantage to harvesting the calf fascia as a vascular pedicle fascial flap, is it’s possible to harvest the fibula flap and sural nerve at the same time. Vascular pedicle nerve transplants are said to recover quickly, however if blood flow is not properly reconstructed, scarring of the soft tissue surrounding the nerve can occur, and this can impede the regeneration of the nerve, so care is required.

Nerve transfer is an option as a surgical method, however in the current day where vascular pedicle nerve transplants are now possible, it is chosen in extremely limited cases.

The difficulty level of each surgical procedure is shown subsequent to the procedure title (e.g., Level of Difficulty: 2). The levels range from 1 to 5, with level 1 indicating a preliminary level and level 5 indicating a very advanced level.