Nerve Graft Harvests
For reconstructions that include nerve autografts, there are available sources for donor nerves in the upper and lower extremity. The decision of which donor nerve to use depends on the case scenario and the patient’s needs during the pre-operative assessment. While sensory nerve graft harvests come at the sacrifice of the sensory territory, over time, these less-critical sensory territories can recovery some rudimentary sensation from adjacent functional sensory territories through collateral sprouting. To increase the potential for restoring rudimentary sensation to these territories, an end-to-side nerve transfer can be elected.
While sensory nerves have proven to be an excellent source for graft material, the surgeon needs to be aware of the anatomical and physiological differences between motor and sensory nerve fibers and consider expendable motor nerve grafts as an option. A nerve gap reconstruction with matched modality can enhance nerve regeneration as seen in experimental animal studies. While there are available sources for nerve grafts, there exist a small percentage of patients who have severe traumatic injuries where nerve autografts are not an option. In these cases, cadaveric allografts are utilized at the expense of immunosuppression.