A nerve grafting is a surgical technique in which a segment of unrelated nerve is used to replace or bridge an injured portion of the nerve. The donor’s nerve serves as a “track” along which axons can grow down to the target area.
Surgery can be done in case a peripheral nerve has become cut or otherwise divided. It is called peripheral nerve reconstruction or Nerve Grafting. The injured nerve is identified and exposed so that normal nerve tissue can be examined above and below the level of injury, usually with magnification, using either loupes or an operating microscope. If a large segment of nerve is harmed, as can happen in a crush or stretch injury, the nerve will need to be exposed over a larger area. Injured portions of the nerve are removed. The cut nerve endings are then carefully reapproximated using small sutures. The nerve repair must be covered by healthy tissue, which can be as simple as closing the skin or it can require moving skin or muscle to provide well-padded coverage over the nerve. The type of anesthesia used depends on the complexity of the injury. A surgical tourniquet is almost always used.
- Age: Recovery of a nerve after surgical repair depends mainly on the age of the patient. Young children can recover close-to-normal nerve function. In contrast, a patient over 60 years old with a cut nerve in hand would expect to recover only protective sensation; that is, the ability to distinguish hot/cold or sharp/dull.
- The mechanism of injury: Sharp injuries, such as a knife wound, damage only a very short segment of the nerve, availing for the direct suture. In contrast, nerves that are divided by stretch or crush may be damaged over long segments. These nerve injuries are harder to treat and have a poorer outcome.
- The level of harm: After a nerve is repaired, the regenerating nerve endings must grow all the way to their target. For example, a nerve injured at the wrist that regularly provides sensation to the thumb must grow to the end of the thumb to provide sensation. The return of function decreases with increased distance from which a nerve must become.