Surgeons at The Ohio State University Wexner Medical Center in Columbus perform intricate nerve repair and related reconstructive procedures. Our doctors treat all types of nerve injuries, including cut, compressed or crushed nerves in your face, shoulders, arms, legs and other parts of the body.
At Ohio State, nationally recognized surgeons perform pioneering procedures to prevent or treat nerve pain, including post-amputation complications. Children and adults enjoy relief from pain and regaining skills, whether it’s waving an arm, texting a friend or learning to walk again.
The multispecialty reconstructive team at the Ohio State Wexner Medical Center includes peripheral nerve surgeons, microsurgeons, neuroplastic and orthoplastic surgeons; neurologists, physical medicine and rehabilitation experts, and other specialists.
Our comprehensive care spans specialties such as cancer, head and skull reconstruction, military medicine, orthopedic care and complex hand reconstruction.
Why is nerve repair and reconstructive surgery done?
Nerves can become severed, damaged, painful or dysfunctional due to:
- Amputation complications
- Repetitive stress
- Other diseases and disorders
Nerve injuries can 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. Left untreated, serious nerve injuries and pain can lead to depression, substance abuse or narcotics addiction.
In addition, phantom limb pain and other problems can occur after amputation. Surgery can reduce pain and improve how a prosthesis (artificial finger, arm or leg) feels. Procedures also enhance prosthetic function, stability and fit for comfort and ease of use.
Ohio State specialists treat nerve and related conditions such as:
- Acute flaccid myelitis (muscle weakness leading to paralysis)
- Brachial plexus neuropathy (nerve damage in upper shoulders)
- 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 such as hip replacement
- Diabetic neuropathy
- Facial nerve disorders including palsy and paralysis
- Nerve decompression after migraine
- Neuritis (nerve inflammation)
- Neuralgia (intense nerve pain)
- Neurogenic thoracic outlet syndrome (compressed brachial plexus)
- Parsonage-Turner syndrome
- Post-amputation limb pain
- Traumatic nerve injury (nerve cut/transection, crush or stretch)
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)
- Nerve or muscle pain
- Poor wound healing
- Swelling or fluid accumulation
Risks of amputation and other nerve and orthopedic procedures
Multiple traumatic injuries and conditions such as diabetes, heart disease or infection increase the chance of complications. Clotting risks may increase due to postoperative immobility. Additional risks include:
- Deep tissue infections
- Bone fracture
- Implant bending or breaking
- Joint deformity
- Local skin infections
- Muscle pain
- Pressure ulcers
- Skin flap necrosis
- Wound reopening
Peripheral nerve procedures
It’s important to get early, expert evaluation for any type of nerve injury. Certain treatments such as nerve transfer procedures are only effective if the surgeon operates within one year of the injury. If you’ve been injured or experience symptoms such as tingling, pain, numbness, paralysis, see a nerve specialist at Ohio State for personalized evaluation and care recommendations.
Nerve procedures at Ohio State include:
- Nerve transfer — This surgery improves feeling and function in your upper or lower body, depending on the nerve injury, 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 in order to restore movement or feeling to the injured face, hand, arm, shoulder, leg or hip.
- Nerve decompressions — Surgeons cut soft ligament tissue to free painful compressed nerves. Carpal tunnel syndrome can be caused by repetitive stress injuries of the wrist. Similar conditions include nerve pain in the elbow and forearm (radial and cubital tunnel). Surgeons also treat compressed nerves in your legs, feet and ankles (femoral and peroneal neuropathy, diabetic neuropathy, and tarsal tunnel syndrome).
- 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 and is not time sensitive.
- 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. Your surgeon may discuss these and other reconstructive methods.
- Targeted muscle nerve reinnervation (TMR) — TMR 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 of muscle. Rerouting specific nerves to specific muscles, offers more refined movements and range of motion when combined with an advanced prosthetic. It can improve your ability to control an artificial arm or upper-body prosthetic.
- Facial reanimation — This procedure restores muscle movement and facial function after nerve and muscle trauma.
Advanced limb amputation
After amputation, severed nerves sometimes heal abnormally. Nerves may retract and pull back, or a disconnected nerve may try to regrow with no destination. Scarred nerve endings and painful neuromas can develop. Electrical signals may misfire when random circuits aren’t redirected. Related symptoms include:
- Phantom limb sensations — Feeling like a missing limb is still there
- Phantom limb pain — Discomfort that seems to come from the missing limb
- Residual limb pain (RLP) — Pain in remaining portion of limb
Amputation-related procedures include:
- Targeted muscle reinnervation (TMR) —TMR relieves pain and improves function by redirecting painful, abnormal nerves and nerve growth after injury or amputation. Surgeons reroute cut or damaged nerves and severed nerve endings into motor nerves in nearby muscle. Surgeons can perform TMR during an amputation or weeks and even years later.
- Osseointegration (OI) — After amputation, surgeons place a metal implant in the remnant limb. This two-part procedure may be part of an amputation or done later to relieve painful post-amputation complications. OI improves the fit, stability, comfort and function of an artificial limb. Once the metal implant bonds with bone tissues within a few months, doctors perform residual limb optimization.
- Residual limb optimization — After amputation, surgeons shape the remaining limb for form and full soft-tissue coverage, protection and comfort. They customize a smooth, tailored fit for the prosthesis.
- Soft tissue revision — This surgery corrects post-amputation complications such as skin irritation, infection, pinched nerves, painful scars and prosthesic discomfort. Surgeons treat damaged nerve endings and bone tissue while reshaping the limb remnant to enhance fit.
Limb preservation and reconstruction
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 function and quality of life. Related nerve procedures include microsurgery, complex trauma reconstruction and cancer-related reconstructive surgery.
Preparing for nerve repair and reconstructive surgery
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
- Magnetic resonance imaging (MRI)
- Nerve conduction study
- Nerve stimulation test
- Muscle function test
- Limb evaluation
- 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. We encourage you to ask questions and notify your doctor if your condition changes.
Nerve and orthopedic surgeries are usually done under general anesthesia.
This minimally invasive surgery can take less than an hour or longer than an hour depending on treatment goals. It’s most commonly an outpatient procedure, but more complex surgeries can require an overnight stay. The doctor will make an incision and cut targeted compressive tissue to relieve pressure around the entrapped or compressed nerve. The nerve is freed from the soft tissue and is not cut.
Nerve repair, nerve transfer and reconstruction
Nerve procedures may include one or more the following procedures and techniques. Steps of surgery vary depending on your condition and treatment plan as discussed by your surgeon.
- Nerve repair – When a nerve is injured, the surgeon may be able to perform a direct repair and reconnect the two ends together using small suture and a microscope. This will allow the nerve to regrow to the injured muscle or skin.
- Nerve transfer – To perform a nerve transfer, the surgeon will make incisions to expose targeted nerves. They will evaluate healthy and damaged nerve and muscle function. They will use a handheld nerve stimulator to identify donor and recipient nerve branches.
- The surgeon will rewire a healthy nerve from a donor nerve on your body as discussed in your pre-surgery visits. The surgeon will connect the healthy nerve to the injured nerve to speed up and improve muscle movement or feeling to the injured area.
- Nerve gap reconstruction – Severe trauma sometimes involves large sections of crushed or missing nerves. To bridge the gap between the nerve ends, surgeons may repair the nerve using your own extra nerve tissue (autograft) or with off-the-shelf processed human nerve graft material from cadavers (processed nerve allograft). This reconstruction allows the nerve to grow through the “extension cord” to restore motion and sensation.
- Free functional muscle transfer – During a free functional muscle transfer, the surgeon will remove donor muscle tissue — including nerves and blood vessels — from a healthy area of your body. Your surgeon transplants this free flap onto the injured limb in order to replace the injured muscle. This procedure is highly specialized and can be performed in the face, arms and legs.
- Targeted Muscle Reinnervation – In the cases of nerve pain and/or amputation, the surgeon can rewire and transfer the injured nerve to a nerve in a nearby muscle target. We call this targeted muscle reinnervation (TMR). Learn more about what to expect during and after TMR.
- Microsurgeons may use powerful magnification technology and tools to re-attach tiny blood vessels, nerves and tissues.
- For certain conditions, your surgeon may perform limb salvage and reconstruction or cancer-related reconstruction.
Procedures vary depending on the limb and type of amputation, such as below, through or above a joint. Your doctor will take these steps, often in combination with our Orthopedic colleagues:
- The surgical area is cleansed with antiseptic. The surgeon will evaluate skin temperature, color and condition in the treated limb.
- The doctor will make an incision and further evaluate the limb condition. While removing bone and crushed or diseased tissues, the surgeon will keep as much healthy bone and skin as possible. This helps preserve length and sufficiently cover the remnant limb with a flap of remaining healthy tissue.
- The surgeons contour the residual limb to shape the area for improved protection of the bone and critical structures such as blood vessels and nerves, for improved appearance and ideal prosthetic fit. For some conditions, doctors perform other types of surgical reconstruction.
- For a complex condition with a higher risk of infection, your doctor may decide to perform open flap surgery instead of closing the surgical wound and skin flap right away (closed flap surgery). During open flap surgery, the surgeon covers the wound and skin flap with sterile protective dressings. Over the next few days, specialists will examine the wound and clear away any infected tissues. Once the area is clean and infection-free, your surgeon will close the wound and skin flaps.
- The surgeon will cover wounds and may add fluid-drainage tubes and a protective sock. They may put the limb in a splint.
OI techniques vary and may be part of an amputation or done alongside other procedures. Your surgeon will discuss procedure steps during your pre-operative visits.
- During OI, the doctor will shape soft external tissues and create space within the bone to receive the implant before placing the metal implant. Implants vary in material, length and style, such as a rod, screw or tripod. The doctor will position the implant, trim and shape tissues, and close and cover the incision.
- Once the implant fuses and heals within a few months, you’ll have a limb optimization procedure under local anesthesia. The surgeon will visually inspect the implant. They may use advanced imaging technologies for guidance to ensure a tailored, secure and comfortable prosthesis connection. The surgeon will add silicone or other attachments to the limb to protect the implant and prevent skin damage.
- The surgeon will layer wound dressings over the implant area, reinforcing it with sterile gauze sponges. They may place a silicone cap over the stem to compress and secure the sponges.
Your doctor and care team will guide your recovery, including wound care, rehab and follow-up. Your first OI may require a three- or four-day hospital stay. After the second procedure, you’ll begin rehab. If you have lower limb OI, you should be able to walk without crutches once comfortable with the new prosthesis. Your rehabilitation team will guide you through recovery for specific upper and lower limb OI procedures.
Surgery times vary and can take two to five hours or more, depending on your condition and treatment as discussed with your doctor. Minimally invasive outpatient procedures won’t require a hospital stay. For others, hospital stays can range from a day to a week or longer, with inpatient rehabilitation.
After nerve repair and reconstruction
After surgery, your doctor and care team will monitor your condition, including circulation and skin sensation. Your doctor will discuss recovery steps and timeframe, pain management, wound and home care. Certified specialists will assist with fitting and using an artificial limb. Depending on your surgery, you’ll begin rehabilitation therapies, such as:
Your doctors may recommend support groups or counseling to help with lifestyle and emotional challenges after nerve injury, amputation or other traumatic injuries.
Why choose Ohio State for nerve repair and reconstruction?
Ohio State offers advanced multispecialty expertise and comprehensive, highly individualized care from exceptional surgeons.
- Ohio State excels in advanced research and surgical care — including 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 for children and adults with serious muscle and nerve injuries.
- Our multispecialty programs consistently rank among the nation’s best. As an academic medical center, Ohio State is home to surgeons who use the latest technologies and techniques to improve outcomes and quality of life, including:
- 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 innovated and comprehensive care.
- 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 and blood flow after treatment.
- Microsurgery and super-microsurgery specialization — Our microsurgeons operate with meticulous precision, using powerful magnifying tools and technologies for exacting procedures. Superior accuracy and control is less invasive, improves results and streamlines healing.
Our team of nerve repair and reconstructive specialists
Ohio State reconstructive surgeons and nerve specialists are leaders in the field, from clinical care guided by fellowship-level expertise to research and faculty leadership in academic arenas. Ohio State’s reconstructive surgery team includes specialists who bring complementary skills to the team: