Peripheral Nerve Surgery: The Fine Art of Reconstruction

Peripheral nerve surgery is one of the most delicate and demanding specialisms in modern medicine. As a sub-speciality of various surgical disciplines – in particular plastic and reconstructive surgery, as well as neurosurgery and hand surgery – it deals with the diagnosis and surgical treatment of diseases, injuries and tumours of the peripheral nervous system – that is, all nerves outside the brain and spinal cord.

This article explains, in a clear and concise manner, what peripheral nerve surgery involves, what problems it addresses, and why expertise in this field is a key indicator of quality for a plastic surgeon.

What is peripheral nerve surgery?

Peripheral nerve surgery is a highly specialised branch of surgery that deals with the surgical restoration of function in damaged peripheral nerves.

Using microsurgical techniques, it aims to improve or restore motor functions (movement) and sensory functions (sensation) following injuries or in cases of compression syndromes.

What conditions does peripheral nerve surgery treat?

The areas of application are diverse and often have far-reaching implications for patients’ quality of life. A distinction is mainly made between three categories of problems:

Surgical instruments: How are nerves repaired?

Peripheral nerve surgery requires specialised, high-precision techniques, which are carried out under an operating microscope.

• Neurolysis (nerve exposure): In cases of compression syndromes, the constricting tissue (e.g. ligaments, scar tissue) is carefully cut away to restore space for the nerve and relieve the pressure.
• Nerve reconstruction (nerve suture): A cleanly severed nerve can be sutured back together immediately, provided that the ends can be brought together without tension. Under the microscope, the surgeon joins the delicate nerve sheaths using extremely fine sutures, so that the nerve fibres can find their way back to one another.
• Nerve transplantation: If, following an injury, a section of the nerve is missing and the ends can no longer be joined without tension, the gap must be bridged using a graft. To do this, a non-essential sensory nerve (e.g. the sural nerve from the lower leg or the medial cutaneous nerve of the forearm) is typically harvested and used as a „guide“.

Relevance to Plastic and Aesthetic Surgery

Although peripheral nerve surgery is primarily aimed at rehabilitation following injuries or illnesses, the skills acquired through it are of fundamental importance for safety and quality in cosmetic surgery.

1. Preventing complications: In procedures such as a forehead lift or facelift, important facial nerves run directly through the surgical site. A surgeon with expertise in neurosurgery is familiar with the precise anatomy and has mastered the delicate dissection techniques required to protect these nerves and minimise the risk of paralysis.
2. Treatment of complications: Should a rare nerve injury nevertheless occur during a cosmetic procedure, a specialist trained in microsurgical nerve surgery (e.g. a plastic surgeon, hand surgeon or neurosurgeon) is best qualified to treat this complication professionally and to strive for the best possible recovery.

Risks and safeguards for complex procedures

Nerve surgery is a complex and lengthy procedure. Nerve regeneration is a slow process (approximately 1 mm per day), and the outcome is not always entirely predictable. Complications such as a failure to regain function or the formation of painful neuromas are possible.

In particular, if nerve reconstruction becomes necessary as a result of a complication arising from cosmetic surgery, there is no guarantee that the costs will be covered by health insurance. A Consequential Costs Insurance is designed to cover the financial costs of medically necessary treatment following complications arising from an insured cosmetic procedure.

Frequently Asked Questions (FAQ) on Peripheral Nerve Surgery