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Novel Uses of Nerve Transfers.

ABSTRACT: Nerve transfer surgery 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. Nerve transfers were originally popularized for the restoration of motor function in patients with peripheral nerve injuries. However, more recently, novel uses of nerve transfers have been described, including nerve transfers for sensory reinnervation, nerve transfers for spinal cord injury and stroke patients, supercharge end-to-side nerve transfers, and targeted muscle reinnervation for the prevention and treatment of postamputation neuroma pain. The uses for nerve transfers and the patient populations that can benefit from nerve transfer surgery continue to expand. Awareness about these novel uses of nerve transfers among the medical community is important in order to facilitate evaluation and treatment of these patients by peripheral nerve specialists. A lack of knowledge of these techniques continues to be a major barrier to more widespread implementation.

SUBMITTER: Wilson TJ

PROVIDER: S-EPMC6361052 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Novel Uses of Nerve Transfers.

Wilson Thomas J TJ

Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics 20190101 1

Nerve transfer surgery 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. Nerve transfers were originally popularized for the restoration of motor function in patients with peripheral nerve injuries. However, more recently, novel uses of nerve transfers have been described, including nerve transfers for sensory reinnervation, nerve transfers for spinal cord injury and stroke patients, ...[more]

PMID: 30267204

Similar Datasets

Nerve transfers in tetraplegia I: Background and technique.

Project description:BackgroundThe recovery of hand function is consistently rated as the highest priority for persons with tetraplegia. Recovering even partial arm and hand function can have an enormous impact on independence and quality of life of an individual. Currently, tendon transfers are the accepted modality for improving hand function. In this procedure, the distal end of a functional muscle is cut and reattached at the insertion site of a nonfunctional muscle. The tendon transfer sacrifices the function at a lesser location to provide function at a more important location. Nerve transfers are conceptually similar to tendon transfers and involve cutting and connecting a healthy but less critical nerve to a more important but paralyzed nerve to restore its function.MethodsWe present a case of a 28-year-old patient with a C5-level ASIA B (international classification level 1) injury who underwent nerve transfers to restore arm and hand function. Intact peripheral innervation was confirmed in the paralyzed muscle groups corresponding to finger flexors and extensors, wrist flexors and extensors, and triceps bilaterally. Volitional control and good strength were present in the biceps and brachialis muscles, the deltoid, and the trapezius. The patient underwent nerve transfers to restore finger flexion and extension, wrist flexion and extension, and elbow extension. Intraoperative motor-evoked potentials and direct nerve stimulation were used to identify donor and recipient nerve branches.ResultsThe patient tolerated the procedure well, with a preserved function in both elbow flexion and shoulder abduction.ConclusionsNerve transfers are a technically feasible means of restoring the upper extremity function in tetraplegia in cases that may not be amenable to tendon transfers.

| S-EPMC3172032 | biostudies-literature

Motor nerve transfers to restore extrinsic median nerve function: case report.

Project description:Active pronation is important for many activities of daily living. Loss of median nerve function including pronation is a rare sequela of humerus fracture. Tendon transfers to restore pronation are reserved for the obstetrical brachial plexus palsy patient. Transfer of expendable motor nerves is a treatment modality that can be used to restore active pronation. Nerve transfers are advantageous in that they do not require prolonged immobilization postoperatively, avoid operating within the zone of injury, reinnervate muscles in their native location prior to degeneration of the motor end plates, and result in minimal donor deficit. We report a case of lost median nerve function after a humerus fracture. Pronation was restored with transfer of the extensor carpi radialis brevis branch of the radial nerve to the pronator teres branch of the median nerve. Anterior interosseous nerve function was restored with transfer of the supinator branch to the anterior interosseous nerve. Clinically evident motor function was seen at 4 months postoperatively and continued to improve for the following 18 months. The patient has 4+/5 pronator teres, 4+/5 flexor pollicis longus, and 4-/5 index finger flexor digitorum profundus function. The transfer of the extensor carpi radialis brevis branch of the radial nerve to the pronator teres and supinator branch of the radial nerve to the anterior interosseous nerve is a novel, previously unreported method to restore extrinsic median nerve function.

| S-EPMC2654949 | biostudies-other

Nerve transfers for adult traumatic brachial plexus palsy (brachial plexus nerve transfer).

Project description:Adult traumatic brachial plexus injuries can have devastating effects on upper extremity function. Although neurolysis, nerve repair, and nerve grafting have been used to treat injuries to the plexus, nerve transfer makes use of an undamaged nerve to supply motor input over a relatively short distance to reinnervate a denervated muscle. A review of several recent innovations in nerve transfer surgery for brachial plexus injuries is illustrated with surgical cases performed at this institution.

| S-EPMC2504085 | biostudies-other

Median nerve mistaken for palmaris longus tendon: restoration of function with sensory nerve transfers.

Project description:Intraoperative iatrogenic nerve injuries occur despite vigilance in the operating room. Most of these injuries occur as a result of patient positioning, traction or pressure injury, hematoma, or technical error. The median nerve is especially susceptible to injury during carpal tunnel release. A rare but devastating injury of the median nerve is complete transection. The number of devastating injuries is not well known, as few of the injuries are documented or publicized. We report a case where the median nerve was harvested instead of the palmaris longus tendon. We present a review of the literature and suggest an alternative treatment to median nerve grafting using sensory nerve transfers in the hand.

| S-EPMC2526034 | biostudies-other

Proof of concept for multiple nerve transfers to a single target muscle.

Project description:Surgical nerve transfers are used to efficiently treat peripheral nerve injuries, neuromas, phantom limb pain, or improve bionic prosthetic control. Commonly, one donor nerve is transferred to one target muscle. However, the transfer of multiple nerves onto a single target muscle may increase the number of muscle signals for myoelectric prosthetic control and facilitate the treatment of multiple neuromas. Currently, no experimental models are available. This study describes a novel experimental model to investigate the neurophysiological effects of peripheral double nerve transfers to a common target muscle. In 62 male Sprague-Dawley rats, the ulnar nerve of the antebrachium alone (n=30) or together with the anterior interosseus nerve (n=32) was transferred to reinnervate the long head of the biceps brachii. Before neurotization, the motor branch to the biceps' long head was transected at the motor entry point. Twelve weeks after surgery, muscle response to neurotomy, behavioral testing, retrograde labeling, and structural analyses were performed to assess reinnervation. These analyses indicated that all nerves successfully reinnervated the target muscle. No aberrant reinnervation was observed by the originally innervating nerve. Our observations suggest a minimal burden for the animal with no signs of functional deficit in daily activities or auto-mutilation in both procedures. Furthermore, standard neurophysiological analyses for nerve and muscle regeneration were applicable. This newly developed nerve transfer model allows for the reliable and standardized investigation of neural and functional changes following the transfer of multiple donor nerves to one target muscle.

| S-EPMC8530510 | biostudies-literature

Uses of skin biopsy for sensory and autonomic nerve assessment.

Project description:Skin biopsy is a valuable diagnostic tool for small-fiber-predominant neuropathy by the quantification of intraepidermal nerve fiber density (IENFD). It has the unique advantage of being a minimally invasive procedure with the potential for longitudinal evaluation of both sensory and autonomic fibers. Unmyelinated small fibers are not otherwise quantified objectively with such a level of sensitivity as has been reported with IENFD. Recent advances include an expansion of the skin punch biopsy technique to evaluate larger myelinated fibers and mechanoreceptors, and recent work has also focused on additional methods of quantifying dermal fibers and densely innervated autonomic structures. This review discusses current work using skin biopsy for the pathologic analysis of peripheral nerve fibers in neuropathy of various causes as well as its use in clinical trials.

| S-EPMC3684157 | biostudies-other

Demystifying Targeted Muscle Reinnervation: A Systematic Review of Nerve Transfers for the Lower Extremity.

Project description:Targeted muscle reinnervation (TMR) outcome studies reveal the benefit amputees experience and the potential functional improvement by optimizing neurocutaneous signaling for myoelectric prosthesis control. However, there are still many settings where these techniques are not offered to patients requiring lower extremity amputations or neuroma reconstruction. With growing consistency in the literature, it is helpful to systematize the nerve transfers described for lower extremity TMR and to simplify its integration into reconstructive care.MethodsA systematic literature review was performed and contained the following inclusion criteria: original cases of primary or secondary lower extremity amputation defects or nerve-related pain that underwent TMR with clearly described target muscles for each nerve transfer. Studies were excluded if the cases had been previously described or contained incomplete data. The primary outcomes were nerves transferred and muscles targeted. Target muscle options were presented in tables specific to anatomic region, and cross-sectional schematics were created for intraoperative assistance.ResultsSeventeen studies presenting original cases with clearly described nerve transfers and target muscles in the lower extremity were included in the review. Target muscle selection for all nerve transfers at the transfemoral and transtibial levels were presented in separate tables.ConclusionsReports of early experience at multiple institutions identify trends in the selection of certain target muscles for nerve transfers in transfemoral and transtibial TMR. Familiarity with these common target muscles and nerve transfers can simplify intraoperative decision-making and enhance integration of lower extremity TMR in amputation care and in the treatment of nerve-related pain.

| S-EPMC10010850 | biostudies-literature

A comparison of the effects of agricultural pesticide uses on peripheral nerve conduction in China.

Project description:Evidence on the adverse effects of agricultural pesticide use by farmers under the actual field conditions on their peripheral nerve conduction in China is limited. This study was to investigate the association of agricultural pesticide use with the abnormalities of farmers' peripheral nerve conduction based on two rounds of conventional nerve conduction studies. The level of pesticide exposure was assessed by measuring total amount of pesticides used by farmers in 2012. The logistic and negative binomial regression analyses were performed on a cohort study of 218 farmers. Results show that agricultural use of neither glyphosate nor non-glyphosate herbicides was not found to induce the abnormalities of farmers' peripheral nerve conduction. However, agricultural use of organophosphorus compounds was significantly associated with increased risk of demylination disease of peripheral nerve conduction described by the reduced velocity. Moreover, the use of organonitrogen compounds by farmers would not only increase risk of demylination disease but axonal damages described by the reduced amplitude. By contrast, agricultural uses of organosulfur and pyrethroid compounds would not induce the abnormalities of farmers' peripheral nerve conduction. The findings demonstrated the importance of developing health-friendly pesticides to replace organophosphorus and organonitrogen insecticides and fungicides in China.

| S-EPMC6018562 | biostudies-literature

Serial transfers study

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| PRJEB71348 | ENA

?-Catenin uses a novel mechanism to activate vinculin.

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