By performing a nerve transplantation we are trying to restore the anatomy of the network of nerves ( brachial plexus) that are exiting through the vertebral foramina of the neck. For that reason, the network of nerves ( brachial plexus) has to be surgically exposed from its points of exit through the vertebral bodies to the point of their target organs (muscles, for example biceps). During this surgical preparations, one or more injuries can be identified ( for example supraclavicular- above the level of the clavicle, infraclavicular – under the level of the clavicle, axillary or even more distally located :like the upper or underarm etc.). The operation is performed with the use of magnifying glasses and a surgical microscope. When the injury is identified, the scar caused from the accident can also be removed. The scar tissue is developed while the body is trying to heal the trauma and cover the gap between the nerve fibers. A spontaneous regeneration is though not possible after a complete dissection of the nerves. Instead , the scar tissue acts as a blocking agent and during a nerve transplantation has to be removed. After the removal of the scar tissue, a sensory nerve of the skin can be harvested from the lower leg at the level of ankle ( sural nerve). This nerve can be surgically removed though a 4 cm long cut and then be used as a donor nerve for the transplantation. After removal of the sural nerve , sensory deficits can arise as its area of innervation (external side of the foot) . Fortunately, this sensory deficits do not last long since, in no longer than a year, the neighboring nerves become responsible for the sensory innervation of the outer side of the foot. After the sural nerve is harvested, its length is adjusted to the distance needed to bridge the defect of the brachial plexus. Since the sural nerve is harvested in its entire length up to the level of the popliteal fossa (back of the knie), which in an 180 cm tall adult person measures about 30cm, by using a special catheter in an endoscopically and minimal invasive manner , it could be divided in many smaller pieces in order to bridgeseveral defects of the brachial plexus. To serve this purpose we use an operational microscope and by doing so we are able to identify the injuries of the brachial plexus and bridge these with our sural nerve transplants. The brachial plexus displays a fascicular organisation which allows us, in case of a trauma, to identify the injury and simultaneously bridge microsurgically these defects. In this way, the reconnected nerves can, at a later time, give spouts overriding the injured areas and innervate the formely deinnervated muscles ( muscles that receive no impluses because of damage to their nerves). The nerve growth however has a rate of about 1 mm per day, which means that in the case of greater defects a timeframe of two years could be needed before the muscles are reinnervated. After a nerve transplantation we always follow up our patients in our clinic for plastic, hand and reconstructive microsurgery in Berlin intesively .Image. Nerve transplantation at the level of the armpit. Several sural nerve transplants lay next to each other

This post is also available in: German, Arabic, Russian

Prof. Sinis Auszeichnungen

Animated Social Media Icons Powered by Acurax Wordpress Development Company