Is it possible to reattach nerves

In some cases, MRI may be used to directly image the nerve as well. Serial electrical studies may be performed at bimonthly intervals to look for signs of early recovery. If recovery fails to occur at this point, surgical reconstruction is usually necessary. Surgical nerve repair involves exploration of the injured nerve and removal of injured tissue or scar from the nerve endings.

After that, a nerve can be directly reconnected if there is enough length on the ends to allow for a good quality repair without tension.

Repairs are performed with the assistance of an operating microscope to allow for the best alignment of the fiber bundles, called fascicles, inside of the injured nerve. In some cases when a larger amount of tissue has to be removed from the nerve endings, there is too large a gap to allow for direct repair. In those cases, a non-essential nerve will be sacrificed from a separate location on the body usually from the leg or upper arm and used to bridge the nerve gap.

This procedure is known as nerve grafting. Other approaches for repair such as a conduit, an artificial tube connecting the nerve endings, may be used in particular circumstances when grafts are not possible.

Nerve graft substitutes, derived from donated nerve tissues, are also appropriate instead of nerve grafting for some patients. After a nerve is repaired, the fibers within the nerve begin to grow from the repair site toward the lost target tissues of skin and muscle to restore sensation and movement. The progress of recovery can be followed by the location of a sensitive area within the reconstructed nerve which will tingle when tapped.

These are the advancing nerve fibers within the recovering nerve. Hand therapy or physiotherapy will allow movement to be maintained while the nerve cells regenerate. As your nerve recovers, the area the nerve supplies may feel quite unpleasant and tingly. This may be accompanied by an electric shock sensation at the level of the growing nerve fibres; the location of this sensation should move as the nerve heals and grows. Over time, these feelings subside and the area should begin to feel more normal.

Unfortunately, nerves never recover completely after they have been cut. I use a microscope or magnifying glasses loupes to repair your cut nerve with sutures finer than a human hair. This type of nerve repair surgery has the best recovery rates. Whether or not I can perform direct nerve repair on your injured limb depends on the injury your nerve has suffered. Sometimes I cannot directly repair your nerve ends, for example, if there is a piece of nerve missing or a delay in repair.

With nerve grafting, I take a length of nerve from somewhere else in your body and place it as a graft. I perform this repair using a microscope, too.

You will have a scar from the surgery and often a numb patch in the area I took the nerve graft from. Possible donor nerves include sensory nerves of skin of the forearm and leg. Having a numb patch on the side of your arm or foot is usually less bother than having a numb area on your hand.

As with all procedures I perform, we will have an in-depth consultation about all aspects of the surgery and recovery, including possible donor nerves, risks etc.

The nerve may have been repaired, and some recovery of function may have occurred, however scar tissue around the nerve causes tethering and discomfort when you move your hand. The scar tissue can also limit nerve cell regeneration. I can surgically release the scar tissue from around the nerve.

Your nerve may fail to recover due to a neuroma link to the top of the page , or there is a persistent gap in the nerve. During the procedure, I cut back your nerve ends until I can see healthy ends, and I place a piece of nerve graft to facilitate normal re-growth of your nerve. The function sensation and power of your nerve is initially worse and then should gradually improve — it will be like beginning recovery all over again.

Show references Peripheral neuropathy fact sheet. National Institute of Neurological Disorders and Stroke. Accessed Jan. Nerve injuries. American Academy of Orthopaedic Surgeons. Rutkove SB. Overview of upper extremity peripheral nerve syndromes.

Overview of lower extremity peripheral nerve syndromes. NINDS pinched nerve information page. Azar FM, et al. Peripheral nerve injuries. In: Campbell's Operative Orthopaedics. Elsevier; Daroff RB, et al. Trauma of the nervous system: Peripheral nerve trauma. In: Bradley's Neurology in Clinical Practice. Neurological diagnostic tests and procedures fact sheet.

Neligan PC. Peripheral nerve injuries of the upper extremity. Elsevier Saunders; Pain: Hope through research.