Know the Nerve Transplant Procedure and Its Use

A nerve transplant or nerve graft is a procedure to replace and reconnect injured nerves. Nerves that are used as substitutes can come from the patient's own body or from a donor.

Nerves function to send signals from the brain to the rest of the body and vice versa. When nerves are damaged by pressure, stretching, or injury, this signaling function is impaired. As a result, the area controlled by these nerves may experience numbness. If the damaged nerve is in a muscle, it can affect movement.

Nerve transplantation is done by removing the damaged part of the nerve, then connecting the two nerve endings with nerves taken from other parts of the body. There are 2 methods for performing a nerve transplant, namely:

Autologous nerve graft or autograft, which is a nerve graft which is done by taking nerves from the patient's own body part
Allogenic nerves graft or allograft, namely a nerve graft by taking a replacement nerve from the body of another person (donor)

Purpose and Indications for Nerve Transplant

Nerve transplants are performed on patients who have lost sensation and nerve function due to injury. Some types of injuries that may cause nerve damage and need to be treated with a nerve transplant are:

Closed injury (inside the body), either due to a fall or accident, which does not improve for up to 3 months after the injury
An open wound due to a tear or tear affecting a nerve, especially if it causes numbness or muscle weakness
Injuries that cause crush injuries or nerve damage, for example from fractures, hematomas (abnormal accumulation of blood outside blood vessels), and compartment syndrome.

Nerve transplantation is also intended for patients with neurological disorders due to disease or complications after surgery, especially those that cannot be cured by drugs or therapy.

Precautions Before Performing a Nerve Transplant

There are several things to know before performing a nerve transplant, including:

Nerve transplantation can only be done if the length of the nerve to be replaced is no more than 3 cm, because this procedure requires a donor nerve that is 10–20% longer than the length of the injured nerve.
Nerve transplantation by the method autograft It can cause infection, numbness, and loss of nerve function in the area where the nerve is removed.
Autograft cannot be performed if the injured nerve is too long. This is due to the limited availability of replacement nerves.
Nerve transplantation by the method allograft can trigger a rejection reaction from the donor recipient's body.
To prevent side effects of the method allograft, the patient will be given drugs that suppress the immune system (immunosuppressants). However, this risks making the patient more susceptible to infectious diseases.

Preparation BeforeNerve Transplant

If you are going to have a nerve transplant, tell your doctor about your medical history, including if you have any drug or other allergies. You should also provide information about any medications you are currently taking and tell your doctor if you frequently drink alcohol or abuse drugs.

Discuss with your doctor about the length of treatment, whether or not you need to bring your family to accompany you home from the hospital, and the right time to start your activities again.

To confirm that the patient has a nerve injury and requires a nerve transplant, the doctor will perform the following tests:

Electromyography (EMG), which is a test to measure how well the muscle's ability to respond to stimuli originating from the nerves
Nerve conduction study (NCS), which is a test to measure electrical activity in the nerves

Nerve Transplant Procedures and Measures

Before the nerve transplant is performed, the doctor will give general anesthesia first. Next, the doctor will perform a nerve transplant whose technique depends on the type of transplant to be performed. Here is the explanation:

Autograft

In this transplant, the doctor will make 2 incisions in the patient's body. The first incision is in the injured area, and the second incision is in the area to be grafted. In most cases, the nerve to be grafted is taken from the arm or leg.

Allograft

Overall, the procedure allograft same as procedure in autograft. The difference is, the doctor makes 1 incision on the injured part of the patient's body, and 1 incision on the part of the nerve to be donated in the donor's body.

After the incision is made, the doctor will cut the nerve to be donated to replace or connect the damaged nerve.

Recovery AfterNerve Transplant

In many cases, nerve transplant patients can return home the same day. However, this really depends on the condition of each patient. Some patients can be hospitalized for several days if their condition is not stable.

After a nerve transplant, your doctor will prescribe medication to relieve pain after surgery. Specifically for patients undergoing allograft, the doctor will give drugs that suppress the immune system (immunosuppressants).

The length of the patient's recovery depends on the length of the nerve removed. During the recovery period, patients are advised to undergo physiotherapy to train and maintain muscle strength.

Please note, the patient will experience numbness in the part of the nerve that was removed, but this will usually recover gradually over a few years.