Direct Muscular Neurotization

Several severe types of injuries are not amenable to traditional techniques of peripheral nerve repair. In these cases, the distal nerve branching and contact points in the end muscles are avulsed, essentially removing the neural portion of the muscle. Direct muscular neurotization often can reconstitute some muscle contraction and function by implanting a nerve graft, divided into several slips, directly into the muscle. This article describes the indications, contraindications, and technical issues associated with direct muscular neurotization.