Paradigm shift in nerve surgery—Mackinnon, Domeshek
Nerve surgery evolved tremendously over recent decades with increased utilization of nerve transfers. In 2017, we surveyed practicing nerve surgeons regarding their use of nerve transfers for motor and sensory reconstructions. 72% of respondents included nerve transfers in their practice. Transfers for proximal plexus and ulnar nerve injuries were most common with fewer performed for median and radial lesions (Table/Figure 1)1. For AIN to ulnar motor transfers, end-to-end coaptations were more popular for proximal lesions while end-to-side was more common for distal injuries. Transfers for sensation were much less common than for motor.
In 2019, we published these survey results along with a review of publication trends and reported outcomes comparing nerve transfers and grafts. Publications on nerve reconstruction increased exponentially after the popularization of grafting, with publications on transfers transcending those on grafting or repair by the mid-2000’s (Fig. 2)1. A review of studies comparing nerve grafts versus transfers showed transfers performing as well as or superior to grafts in both proximal and distal injuries.
Grafting revolutionized nerve surgery in the 1980's.2 Previous work has shown that a new idea needs 17 years to reach a critical mass of early adopters before “tipping” into the mainstream.2,3 Our findings suggest that nerve surgery stands on the cusp of a new paradigm shift as surgeons increasingly embrace transfers to improve outcomes. To further tract the progress of the adoption of these new techniques, we will re-survey nerve surgeons and look forward to communicating that update in Synapse in a future communication.
Table 1. Frequency of Use of Nerve Transfer Surgery for Motor Nerve Injury
Figure 1. Frequency of Use of Nerve Transfer Surgery for Motor Nerve Injury
Figure 2. Annual Publications of Nerve Reconstruction by Type