Nerve Grafting

In order for a nerve to heal properly, healthy fascicles (smaller sub-nerves within the larger nerve) have to be present on either side of the injury. In some cases, this may mean the injured nerve has to be “cut back” until healthy fascicles are seen. This can result in a gap between each end. Nerves that are pulled together in order to repair under tension do not regrow properly. Therefore, we may use a portion of an expendable nerve to “splice“ or graft into the gap to allow axons to grow across. The advantage to this technique is it may allow for motor and sensory fascicles to grow across the gap and provide an option for recovery when no other options exist. However, limitations include two coaptation (connection) sites that the nerve has to grow across, the distance from the site of injury/repair to the motor targets may exceed the critical time window for reinnervation, and the length of graft may be a limitation.

An example of nerve grafting is when there is a complete injury to the brachial plexus (complex arrangement of nerves between the neck and clavicle) and there are no reconstructive options available downstream. In this case, the injured portions of nerve in the brachial plexus may be cut back until healthy fascicles are seen and nerve graft sutured between these ends.

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