Risk and Reward: Avoiding Donor Morbidity and Maximizing Results in Nerve Transfer Surgery

Abstract

Nerve transfers have revolutionized outcomes in brachial plexus and peripheral nerve surgery. The ability to plan and execute effective and safe nerve transfers is now integral to providing contemporary reconstructive nerve surgery. This chapter provides an academic and philosophical approach to patient care. It includes details of preoperative planning and intraoperative techniques in sufficient practical detail to help surgeons both minimize risk and maximize results. This includes thorough discussion of techniques for interfasicular dissection, management of nerve branching, intraoperative nerve mapping, optimizing purity and quality of selected donor nerves and decision-making about donor neurotomy and preferred level of secondary nerve coaptation. These concepts and techniques provide the opportunity to improve results in known and familiar nerve transfers, as well as provide the opportunity to undertake new procedures with the best chance of success and the lowest risk of harm.