What is nerve repair?
Nerve injuries usually occur when there is damage or injury to the hand. Nerves are responsible for sending sensations and messages of movement to and from your brain. If nerves are damaged or cut, you may have reduced or lost sensation, and/or be unable to move your hand properly. Some nerve injuries will repair themselves, however in some cases surgical nerve repair is the best option.
Nerve repair surgery brings the two ends of the cut nerve back together. By bringing the ends together, the ends of the nerve do not have to ‘find’ each other. Nerves left to ‘find’ each other sometimes result in the development of a lump of nerve ends called a neuroma. Neuromas can be quite uncomfortable.
Who is nerve repair surgery for?
The reasons for considering nerve repair surgery will be determined by the extent of damage to your nerve. Some of them may include:
- You have a crush, cut or stretch injury to a nerve in your hand.
- There is numbness or loss of sensation in your hand.
- You have a weakened grip or loss of control of movement.
- The injury site is causing pain or discomfort.
The first step is to make an appointment to see Dr McMillan.
You will meet Dr McMillan at his private rooms in Fernbrae House, Dunedin or in Invercargill to review your nerve damage and discuss the best surgical options for repair. This is an important step; not only gaining an understanding of the expected surgical outcomes but also developing your relationship with Dr McMillan as you work together to establish better sensation and function in your hand.
During the discussion with Dr McMillan, you will work together to decide which type of nerve repair surgery is the right one for you, this will depend on a range of factors. Surgical nerve repair may be as simple as bringing the two cut ends back together, or if the gap between the two cut ends is too large, a bridging technique using a nerve graft will be needed.
Once you have decided on what is to be done, a date will be booked for you at Mercy Hospital, Dunedin to have your nerve repair surgery.
No matter which surgical technique is used, the main purpose of the procedure is to bridge the gap between the two ends of the cut nerve. A general anaesthetic will be required for either technique.
Direct nerve repair: a small cut is made where the damaged nerve is located. Under a microscope or magnifying glasses, the two ends of the nerve are located and sutured back together using ultra fine thread – thinner than a strand of hair.
Nerve grafting repair: when the two ends cannot be sutured together, a nerve graft is used. This will mean using a small piece of nerve from somewhere else. This ‘donor’ nerve usually comes from the forearm or leg. Under a microscope, the nerve graft will then be sutured into place to create a bridge between the damaged nerve ends.
The surgical cuts will be sutured back together.
Dressings will then be placed over the suture lines in your hand, and donor site if you have one. Your hand will be wrapped in a bandage before you head to the recovery room.
Nerve repair surgery is usually a day surgery procedure. You will not need to stay overnight at the hospital. Before you leave hospital, your hand will be placed in a splint to minimise hand movement and allow the nerves to begin healing.
Skin healing will occur over the first week and you may experience some discomfort and tenderness around the surgery area.
To assist in the swift recovery, it is important to engage in physicotherapy after nerve repair surgery for your hand, to improve blood flow, movement and muscle tone in your hand.
There will still be some numbness and reduced movement to the hand as there was before surgery. Hand therapy is essential during this period, both during the first few weeks wearing the splint and afterwards. This aims to improve your hand sensation and movement.
Nerves grow back slowly and the length of time taken for full nerve function to come back will depend on how much damage there was to the nerve originally.
This hand may always be feel "different" as sensation may not return exactly as it was before the initial injury. Movement and sensation should start to feel more normal a few months after the surgical nerve repair.
Risks and complication
As with all surgical procedures, there are risks and potential complications with nerve repair surgery. Dr McMillan will discuss all of these with you during your consultation and answer your questions.
There is a cost to having nerve repair surgery done privately. The exact figure will depend on a range of factors but generally the cost is between $1,800 and $10,000. ACC will generally fund nerve repair or reconstruction required secondary to trauma.
If you have a hand injury with nerve damage start the journey to better function for you and your hand; get in contact to make an initial consultation with Dr McMillan about surgical nerve repair.