Penn neurosurgeons perform different types of surgical techniques including microsurgical nerve suture, nerve grafting and nerve transfers to repair devastating injuries such as brachial plexus trauma.

Dr. Eric Zager and Dr. Zarina Ali

The Penn Center for Peripheral Nerve Disorders provides a comprehensive array of treatment options for patients with a variety of lesions of the peripheral nervous system. If you have tried medication for your condition with little to no results, surgery may be your best option. In most cases, these are peripheral nerve disorders caused by tumors and traumatic and compressive conditions. 

The goal of surgery is to repair the nerves so that function is restored to the area. Depending on the type and severity of the nerve injury, your doctor will discuss different methods of repair and develop a treatment plan that is appropriate for you.

Peripheral Nerve Disorder Surgical Treatments

  • Microsurgery
  • Gracilis free functional muscle transfer
  • Nerve grafting
  • Nerve transfers
  • Multimodality tumor resection
  • Radiation therapy, including proton therapy
  • Ganglionectomy

Gracilis Free Functional Muscle Transfer

The most recent innovation in Penn's Center for Peripheral Nerve Disorders is the performance of gracilis free functional muscle transfers for restoration of movement in paralyzed upper extremities, including the hand and arm. Gracilis free functional transfers help patients who have suffered devastating avulsion injuries, in which a ligament or tendon is pulled away from the bone at the brachial plexus. The brachial plexus is a network of nerves that originates from the spinal cord and controls muscle movements and sensation in the shoulder, arm and hand.

If no direct nerve reconstruction is possible, the multidisciplinary team from Penn Medicine's departments of neurosurgery, orthopaedics and plastic surgery perform the procedure in which the gracilis muscle is transplanted from the patient's inner thigh up to the arm to replace the paralyzed biceps muscle. Using microsurgical techniques, the gracilis muscle's blood supply is connected to local vessels in the chest and a donor nerve from the patient's neck or chest is attached to the gracilis muscle's nerve supply. In approximately 70 percent of cases, useful elbow flexion is restored to the previously paralyzed limb.

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