Advanced Techniques in Microvascular Surgery Help Restore Function and Relieve Pain

The upper extremities are vital for many different everyday activities, in the home and at work. Unfortunately, accidents happen, whether on the job, on the playing field or in the home. When they do, the complex bones, tendons, ligaments and muscles of the hand, wrist, arm and elbow can suffer trauma, such as severe bone fractures, soft tissue injuries, tendon injuries and nerve damage.

Orthopaedic surgeon Todd Wurth, M.D., with the Bone and Joint Institute of Tennessee specializes in the treatment of disease and injury of the upper extremities and hands. He frequently treats patients who are suffering from nerve damage, and often that includes treating patients who have traumatic, catastrophic damage caused by machinery or an industrial accident.

Symptoms of nerve injuries can be different depending on the nerve injured, the type of injury and the severity of the injury, but may include numbness, weakness and pain. Nerve injuries can get better without treatment, but some traumatic injuries may need to be repaired. Traumatic injuries such as those caused from car accidents and other catastrophic events are not clean-cut and typically result in a significant gap in the nerve that must be repaired surgically.

“Nerves are the body’s ‘fiber optic’ system that carry messages between the brain and the rest of the body,” Dr. Wurth said. “If a damaged nerve is thought to be repairable, surgical treatment may consist of a nerve decompression, nerve repair or a nerve graft.”

According to Dr. Wurth, when a nerve is completely severed, surgeons have traditionally performed a nerve autograft, which involved taking a nerve from elsewhere in the patient’s body and grafting it to close the ends of the damaged nerve. The technique was the gold standard for many years, but a newer nerve repair technique called nerve allograft yields better results with fewer side effects. The nerve allograft uses human nerves harvested from cadavers.

When performing a nerve allograft, Dr. Wurth uses microsurgical techniques to remove all the damaged areas of the nerve and inlays the nerve graft to reconnect the damaged nerve tissue. “The grafted piece of nerve tissue acts as a conduit that allows the nerve fibers to regrow,” Dr. Wurth said. “The human body’s capacity to regenerate and heal is quite fascinating, but it does take time and patience for recovery.”

The nerve fibers grow slowly and, in ideal conditions, may grow about 1 inch every month after surgery. “It can take many months for the nerve to finish growing after an injury depending on many factors, including the length that the nerve needs to grow,” Dr. Wurth said. “It can also take this long for muscles to work well again. There might be numbness, pain or a ‘pins and needles’ feeling during the healing period.”

There is also an amazing degree of redundancy in the human body’s design. When a nerve is damaged beyond repair, Dr.Wurth may recommend a tendon transfer, which involves surgery to restore function to critical muscles by transferring tendons from one muscle to another. “Many tendons are designed to do the same job, so we can move a tendon from another location in order to restore function in an upper extremity,” Dr. Wurth said.

Dr. Wurth often sees patients after the bones and soft tissues have healed from an injury, but nerve damage is still causing pain and limiting function. “It is always better to get patients on the front end of an injury and make all repairs, but we have been successful in treating patients a year or two out from their injury,” he said. “It is extremely gratifying when we are able to restore function and relieve pain, especially for patients who have become discouraged and feel hopeless because of a life-altering injury or illness.”

Early recognition and treatment of a nerve injury, along with the recent advances in microsurgical reconstruction, have greatly improved outcomes for patients. Injuries in which restoring function would have been impossible only two decades ago are now being treated with nerve reconstruction, increasing the possibility of a return to an active, productive life.