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Plastic and Reconstructive Surgery

Nerve Injury

Upper extremity (hand / arm) nerve injuries

  • Nerve injuries affecting the fingers
            i.   The nerves of the fingers are called digital nerves. They provide feeling to the fingertips. They are often injured by sharp objects such as broken glass or pocketknives. These injuries are rather common. Surgery may be required to improve sensation in the finger. Such surgery usually requires a period of immobilization followed by hand therapy for several weeks afterward.
  •  Nerve injuries affecting major nerves of the forearm
            i.  Traumatic nerve injuries: There are multiple major nerves in the arm and forearm. Trauma to these nerves can lead to numbness and a decreased ability to move the limb. In some cases surgery can be performed to improve function of the limb. Such surgery may involve the use of donor nerves from the leg (such as the sural nerve).  Sometimes the surgeon can reroute the nerves in the limb to take advantage of stronger nerves in the area to power the weaker ones.  Sometimes other methods are used to try to improve function in the limb, such as tendon transfers.
            ii.   Nerve compression: Children sometimes develop nerve compression syndromes affecting the hand and upper limb.  Carpal tunnel syndrome is the most common. However, there are other forms of nerve compression that, while rare, may sometimes benefit from surgery or other treatment. Such conditions may include thoracic outlet syndrome, carpal  tunnel syndrome and other median nerve entrapments, cubital tunnel syndrome (entrapment of the ulnar nerve at the elbow), and other nerve compression syndromes. 
  • Brachial plexus injuries 
    See OBPP
  • Facial nerve injury  
    See facial palsy clinic

Lower extremity nerve injury 

  • Trauma:  The leg and lower extremity can sustain nerve injuries, which may result in paralysis and numbness.  Sometimes such nerve injuries can be repaired directly using microsutures under the operating microscope. Sometimes a nerve graft, taken from a normal, healthy nerve elsewhere in the body, may be used to improve sensation and movement.    
  • Nerve compression:  Like the upper limb, the leg may also suffer from nerve compression. If necessary, therapy or surgery may be recommended to improve function.  Such conditions may include peroneal nerve entrapment and tarsal tunnel syndrome as well as others.

Painful nerve injuries / neuropathic pain

  • Sometimes nerve injuries result in pain. Surgeons and therapists and other doctors are sometimes able to determine whether the pain may respond to surgical treatment. This is usually determined by taking a very careful complete history combined with a thorough examination of the affected region. In addition, the doctors may perform nerve blocks in order to help improve the pain and help with finding the cause of the pain. In some cases surgery may be recommended to decompress affected nerves or reconstruct damaged ones. 
  • Migraine headaches may sometimes respond to BoTox injections or nerve decompression surgery in highly selected cases. Patients are seen in coordination with the Department of Neurology in order to determine who may benefit from such treatment. Only patients that have failed to respond to medication alone would be seen for consultation for this condition.

Nerve Injury Research

  • The laboratory of Dr. Gregory H. Borschel and Tessa Gordon is actively investigating innovative ways to improve outcomes following nerve injury. Their laboratory is located at the Hospital for Sick Children.  For more information, see Borschel Lab   
  • See Dr. Borschel publications