Rewiring the Peripheral Nervous System

In this chapter, Dr. Khalifeh, Dr. Dibble, Dr. Dy, and Dr. Ray discuss the subspecialty of Peripheral Nerve. Surgery is a mainstay of treatment for common disorders of the peripheral nervous system, including compressive neuropathies, nerve tumors, peripheral nerve sources of pain, and paralyzing nerve injury. The management of peripheral nervous system injury has evolved significantly over the last century, facilitated by the development of macroscopic exploration and repair, microsurgical techniques, neurophysiologic monitoring, and biologic insights into mechanisms of nerve injury and regeneration. Nerve transfers represent a recent innovation in the reconstructive strategy for peripheral nerve injury, resulting in a marked improvement in clinical outcomes. A nerve transfer involves the distal transection and coaptation of a functioning, expendable donor nerve onto a non-functioning recipient nerve. It transforms a proximal nerve injury to a distal repair, taking advantage of the robust regeneration potential of the peripheral nervous system to allow for earlier reinnervation and quicker return of function in a paralyzed target muscle. More recently, nerve transfers can be modified and repurposed to treat neurologic deficits following injury to the central nervous system, including paralysis from spinal cord injury and stroke, with promising results.