The peripheral nervous system is made up of a network of motor and sensory nerves that connect the brain and spinal cord, or the central nervous system, to the body. Injuries to both the central and peripheral nervous systems can be devastating.

Peripheral nerve injuries cause tingling, pain, numbness and paralysis. Depending on the injury, it might be hard or impossible to smile, raise your arm, bend your elbow, make a fist or stand. Some injuries do not result in functional problems, but they cause severe pain. Phantom limb pain and other problems can occur after amputation. Left untreated, both pain and dysfunction can lead to depression, substance use disorders or other mental health conditions.

What is nerve damage surgery?

Fortunately, there are surgical treatment options available for people with peripheral nerve injuries to restore function and improve pain.

During nerve repair surgery, surgeons remove damaged nerves and reconnect remaining nerve ends to healthy nerves. In some cases, surgeons will implant a nerve from another part of the body to bring about better function.

Peripheral nerve injuries occur for many reasons. Some common reasons people experience nerve problems include:

• Trauma
• Cancer
• Amputation complications
• Repetitive stress
• Other diseases

Because nerve damage occurs for a variety of reasons, Ohio State plastic surgeons treat many different conditions that affect your nerves and related systems. Some of the nerve conditions we treat include:

• Acute flaccid myelitis (muscle weakness leading to paralysis)
• Brachial plexus injury
• Cancers including sarcoma, osteosarcomas (bone and spine)
• Carpal tunnel syndrome, cubital tunnel syndrome, radial tunnel syndrome and other compression disorders
• Circulatory disorders
• Complications after previous surgery
• Diabetic neuropathy
• Facial nerve disorders, including palsy and paralysis
• Infection
• Nerve decompression after migraine
• Neuritis (nerve inflammation)
• Neuralgia (intense nerve pain)
• Neurogenic thoracic outlet syndrome (compressed brachial plexus)
• Parsonage-Turner syndrome
• Post-amputation nerve pain
• Traumatic nerve injury (nerve cut/transected, crushed or stretched)

Types of peripheral nerve surgery

It’s important to get early, expert evaluation for any type of peripheral nerve injury. Treatments to restore function, such as nerve transfers, are only effective if the surgeon operates within one year of the injury.

Treatments for nerve pain are not time sensitive and can be performed months to years after the injury. If you’ve been injured or experience symptoms such as tingling, pain, numbness or paralysis, see a nerve specialist for personalized evaluation and care recommendations.

Because our plastic surgeons are experts at nerve repair, they have a variety of options to treat your nerve pain and other nerve-related symptoms. Some nerve surgical procedures we offer at Ohio State include:

Nerve transfer

This surgery improves feeling and function in your upper or lower body, depending on the nerve injury, location length or type of nerve and time from injury. The surgeon rewires a nerve from a healthy part of your body and connects it to an injured nerve to restore movement or feeling.

Nerve decompressions

Surgeons cut ligament soft tissue to free painful compressed nerves, such as those in carpal tunnel syndrome. Similar conditions include nerve pain in the elbow and forearm. Surgeons also treat compressed nerves in your legs, feet and ankles.

Free functional muscle transfer

Doctors transplant a muscle from one part of your body, including its nerve and blood supply, to restore function to the bend of the elbow or fingers. Surgeons can perform this procedure long after the initial injury.

Free flap and other reconstructive techniques

Surgeons use varied methods to close, cover and protect large, complex or severe wounds. Doctors can detach and transplant a flap of your own skin and muscle or other tissues. This encourages healing and can reduce scarring. Microsurgeons take the flap along with its original blood supply (free flap) and reattach the flap’s blood vessels to blood vessels in the injured area.

Targeted muscle reinnervation (TMR)

Targeted muscle reinnervation helps relieve or prevent nerve pain that’s common after nerve injury and amputation. The surgeon reroutes damaged nerves or nerves cut during amputation into nearby motor nerves or muscle.

Facial reanimation

This procedure restores muscle movement and facial function after nerve and muscle trauma.

Advanced amputation procedures

We can relieve phantom limb pain, residual limb pain and other nerve issues for someone with an amputation. These procedures can also help improve function and comfort of prosthetic devices. Surgeries include TMR, osseointegration, soft-tissue revision and agonist-antagonist myoneural interface.

Limb preservation and reconstruction

Limb preservation specialists in Ohio State’s Comprehensive Wound Center use novel treatments for limb-threatening conditions. Early, advanced limb care can prevent the need to remove a diseased limb. It can also improve post-amputation quality of life. Related nerve procedures include microsurgery, complex trauma reconstruction and cancer-related reconstructive surgery.

Preparing for nerve surgery and repair

Before surgery, you’ll have a physical exam and diagnostic testing. The doctor will evaluate your condition, health and medical history, allergies, medications and work history.

Your doctor will arrange lab, imaging and other testing to assess nerve function, tissue damage and healthy tissues before recommending treatments. They may take photographs. Testing can include:

• Bone computed tomography (CT) scan
• Electromyography (EMG)
• Electroneurography (ENG)
• Exploratory surgery
• Gait analysis
• Limb evaluation
• Magnetic resonance imaging (MRI)
• Nerve conduction study
• Nerve stimulation test
• Muscle function test
• Tissue biopsy

What to expect if you have nerve and reconstructive surgery

Your doctor will discuss what to expect before, during and after your procedure, from hospitalization through recovery. Your care team or discharge coordinator will discuss advance arrangements, such as safe transportation and someone to assist you while you recover at home.

Surgical steps vary depending on your treatment plan, the type of surgery you’re having and the body part on which we’re operating. We encourage you to ask questions and notify your doctor if your condition changes.

Nerve and orthopedic surgeries are usually done under general anesthesia. Sometimes they can be done on an outpatient basis, meaning you go home the same day, but often these complex procedures require an overnight stay.

After nerve repair and reconstruction

After surgery, your doctor and care team will monitor your condition, including circulation, function and pain. Recovery after this type of surgery takes time and most often involves physical or occupational therapy. Your doctor will discuss recovery steps and time frame, pain management, wound care and home care. Depending on your surgery, you’ll begin rehabilitation therapies, such as:

• Hand and upper extremity therapy
• Lower extremity and other physical therapy
• Amputee rehabilitation
• Cancer rehabilitation

Your doctors may recommend support groups or counseling to help with lifestyle and emotional challenges after nerve injury, amputation or other traumatic injuries.

Risks of nerve surgery and related procedures

Your doctor will discuss benefits and risks based on your condition and treatment goals. Surgery complications can include bleeding, clots, infection or anesthesia reactions. Other risks include:

• Cardiac and pulmonary complications
• Changes in skin sensation, including numbness
• Muscle weakness
• Necrosis (skin or fatty tissue death)
• Paralysis or continued dysfunction of the affected limb
• Poor wound healing
• Swelling or fluid accumulation

Why choose Ohio State for nerve repair and reconstruction?

Ohio State offers advanced expertise and comprehensive, individualized care from exceptional surgeons.

Other key differentiators:

Ohio State excels in advanced research and surgical care.

We’ve helped pioneer innovative nerve procedures, such as nerve transfers, free functional muscle transfers and TMR. You’re cared for by reconstructive surgery leaders at the forefront of breakthrough research and life-changing nerve care.

Our multispecialty programs consistently rank among the nation’s best.

As an academic medical center, Ohio State is home to surgeons who work collaboratively together to practice advanced and innovative nerve reconstruction. Our surgeons work directly with orthopedic surgery, neurology and physical medicine and rehabilitation physicians to identify and provide the most innovative and comprehensive care.

We use the latest technologies to improve outcomes and quality of life.

Some of the techniques we implement include:

• Limb preservation — Experts collaborate across specialties to protect healthy tissues, speed wound healing and preserve or maximize limb function.
• Noninvasive vascular imaging technology — Doctors can evaluate how much blood flow is present to support wound healing after treatment.
• Microsurgery and super-microsurgery specialization — Our microsurgeons operate with meticulous precision, using powerful magnifying tools and technologies. Superior accuracy and control is less invasive, improves results and streamlines healing.