Muscle and tendon transfers

In case the reconstruction of a nerve is not possible any more or has not been successful, there is still the option to implement a so called muscle and tendon tranfer.

Muscle transfers of this kind have to be worked out together with the patient individually. For this available functions are newly distributed so that the injured function can be carried out again. This is possible with a number of injuries to the nerves, e.g. brachial plexus lesions, with almost any injury to the nerve on the upper or even lower extremety. It is important that every replacement of tendons and muscles has to be planned exactly and clarified with physio therapists prior to the operation. After the usually long period of immobilisation (between 6 and 12 weeks) the patient has to learn that the muscle now has a new function.

Here are a few examples for you: Muscle transfer to reconstruct shoulder abduction

When the shoulder muscles responsible for abduction are paralysed, it is possible to replace the trapezius muscle, so that it can carry out the abduction of the shoulder. Parts of the trapezius are mobilised and fixed in at the upper arm. In order for the muscle to heal in at its new location it needs to be rested for at least 8 to 12 weeks in a splint, in which the arm is held away in 90 degrees from the body completely. Afterwards physiotherapy begins, which has to be carried out extensively. An abduction of the arm from the body of usually up to 60 degrees can be achieved with this method of operation. Sometimes, even better results can be achieved. Transfers to reconstruct wrist, finger and thumb extension

Loss of hand extension is one of the most common paralyses following injury to the radial nerve. Here the wrist, the fingers and the thumb cannot be extended anymore. This is so disabling for every day life that the function should be reconstructed. The inwards bending muscle (Pronator teres) and a muscle bending the wrist (Flexor carpi ulnaris) are used for extension of the wrist and the fingers. For the extension of the thumb the Palmaris longus muscle is used. The transfers are performed in one operation, after which the hand has to be rested in a splint for 6 weeks. Afterwards, intensive physiotherapy takes place, which initially seems very difficult, because the muscles formerly carried out other functions and the patient has to adjust to the new functions. Facial nerve Paralysis

Paralysis of the facial nerve can be a consequence of birth or the removal of tumors in the brain. However, there are cases witout apparent reason. There are different options for operating, depending on the patientís age, that concentrate on the eyes and the mouth. A part of young patientís healthy facial nerve of the opposite side can be used and a symmetrical smile can further be established through transplant of healthy muscle tissue to the other side. The healthy nerve is then not affected.A so called Temporal muscle transfer can be done for to reconstruct the closure of the eyelids. Herefore parts of the temporal muscle can be transferred to the eye so that it can be closed by this muscle. Further, there are possibilities to achieve a certain symmetry of the face by means of a static reconstruction of the corner of the mouth. Extension of the foot (drop foot)

The foot cannot be lifted when the peroneal nerve is injured, leading to the so called drop foot. This is irritating for the patient and disables normal movement. In this case a muscle from the posterior part of the foot should be replaced to the front (so called posterior tibial nerve transfer). The posterior tibialis muscle is removed from the inside of the foot together with its bony insertion and put to the front through the leg. The bone is then fixed to the foot. The foot has to be rested in plaster around the lower leg for 8 weeks. After the muscle has healed in, practicing treatment starts, although a light splint has to remain. Retraining is difficult, because the muscle primarily had a different function. The new function can be learned well throughout treatment, though.