Reconstructive surgery after nerve injuries

If the function of a nerve can no longer be saved or nerve reconstruction simply no longer has any point (later than a year after the injury), the functions of a core nerve can be reconstructed by transferring muscles and tendons. A common example is the reconstruction of the gripping function after radial nerve palsy (drop hand, palsy = paralysis).

Apart from releasing the contracture, attention must be paid to muscle balance. Example: Peroneal palsy - these patients typically have a drop foot and have a so-called steppage gait.

It goes on to cause a shortening of the Achilles tendon and therefore a pointed position of the foot. Normal walking is no longer possible.

Our operation strategy includes the extension of the Achilles tendon and the transfer of the Musculus tibialis posterior from the deep rear lower leg compartment to the front lower leg compartment and then to the foot, to actively enable lifting of the forefoot. This makes it possible to walk normally again
 

Scars caused by the injury can compromise the function of the affected area and can also be painful. Depending on the finding, the scars should by excised (cut out) and the tension of the skin optimised by soft skin tissue so that no new scar contractures form.

Modern procedures, such as surgical needling, are also used in specific cases. Endogenous regeneration and new formation of skin collagen are stimulated through many tiny skin and subcutaneous tissue injuries made by a special surgical tool. The aim is to gain softer and less active scar areas over time.
 

If it is not possible to restore a new balance through the transfer of tendons and muscles, function can be improved by sectioning the bone and correcting the malposition.

In other cases, a fracture can cause the incorrect healing of the bone, making a correction of the axis and the rotation necessary, a so-called derotational osteotomy.

In cases of bone hypoplasia, the bone can be lengthened through a special procedure using external bone clamps. These external clamping devices can achieve bone lengthening of 0.5 to 1 mm per day.

In some cases, severe injuries cause the loss of bone, muscle and skin. Complex tissue transfers from another part of the body become necessary in this case. These so-called free microvascular transfers are carried out by two operation teams. One team prepares the receiving area and the other extracts the respective skin, muscles, bones or tissue combining systems. 

Chronic wounds can occur due to circulation problems, often in the case of Diabetes mellitus. It causes a loss of tissue as well as skin.

This often leads to additional infections. We surgically treat the loss of tissue through skin transplants and through local or free tissue transfers. After the operation, we make use of an excellent team of wound management experts who take care of changing bandages at home.