Nerve Repair (Microsurgery)

Nerve repair (microsurgery) is a surgical procedure in which a surgeon uses a powerful microscope and ultra-fine tools to reconnect or reconstruct a damaged nerve so that feeling and movement can return to the affected part of the body.

Nerves are fragile cables made of thousands of tiny fibres that carry signals between the brain and the rest of the body. When a nerve is cut, crushed, or stretched — for example in a deep hand wound or a serious accident — those signals are interrupted, causing numbness, weakness, or paralysis. During microsurgery, the surgeon trims the damaged nerve ends, lines them up precisely, and stitches them together with sutures (stitches) thinner than a human hair. If a section of nerve is missing, a graft (a short piece of nerve taken from elsewhere in the body, or a synthetic tube) may be used to bridge the gap. The goal is to give the nerve fibres a clear path to regrow and restore function.

This procedure is used whenever a nerve has been damaged severely enough that it cannot heal on its own. The most common situations are traumatic injuries, but nerve repair is also used for certain conditions that compress or destroy nerve tissue over time.

• Lacerations (deep cuts) that have severed a nerve in the hand, wrist, forearm, or fingers
• Crush injuries or avulsion (tearing) injuries from machinery, industrial accidents, or road traffic accidents
• Brachial plexus injuries (damage to the network of nerves that controls the arm and shoulder), including birth-related injuries in newborns
• Nerve damage caused by a tumour (benign or cancerous growth) that must be removed
• Iatrogenic injuries (accidental nerve damage during a previous surgery)
• Chronic nerve compression that has caused permanent damage not reversible by simpler procedures, such as severe carpal tunnel syndrome (a condition where the nerve in the wrist is compressed)
• Facial nerve injuries affecting movement or expression

Not every case of nerve damage requires microsurgery. Doctors will usually consider it unsuitable when the nerve damage is mild and expected to heal on its own, when the patient's general health makes surgery too risky, when too much time has passed since the injury and the muscles are permanently damaged beyond recovery, or when a simpler procedure such as decompression (releasing pressure around the nerve) is enough.

• Mild nerve injury (neuropraxia — temporary loss of function with no structural damage) that typically recovers without surgery
• Very long delays after injury where the target muscles have lost the ability to respond, making repair unlikely to restore function
• Patients with conditions that severely impair healing, where the surgical risk outweighs the likely benefit
• Situations where non-surgical rehabilitation or splinting is sufficient

Nerve repair microsurgery is a complex procedure and, like all surgeries, carries recognised risks — the most important of which is incomplete recovery of nerve function, since nerves regrow very slowly and results are not guaranteed.

• Incomplete or slow nerve regeneration — feeling and movement may not return fully, even after a technically successful repair
• Persistent numbness, tingling, or weakness in the area supplied by the repaired nerve
• Neuropathic pain (nerve pain — a burning, shooting, or electric-shock-like sensation) during or after regrowth
• Neuroma formation (a painful knot of scar tissue where the nerve was repaired or cut)
• Infection at the surgical wound
• Scarring that puts new pressure on the repaired nerve
• Donor-site numbness or weakness if a nerve graft was taken from another part of the body
• Anaesthesia (the medication used to put you to sleep or numb an area) complications, including allergic reactions or breathing difficulties
• Blood vessel injury during the delicate dissection required by microsurgery
• Need for a second operation if the repair fails or a different approach is needed

Preparation for nerve repair microsurgery involves steps before you arrive at hospital, a series of tests, and then what happens in the operating room itself. Because many nerve injuries are emergencies, some of these steps may happen very quickly or in a different order — your surgical team will guide you through what is possible in your specific situation.

Before the operation, the team will usually ask you to fast (nothing to eat or drink) for several hours, following the guidelines of your anaesthetist (the doctor who manages your sleep and pain during surgery). If you take blood thinners, anti-inflammatory medicines, or certain supplements, the team will advise whether these need to be paused, since they can increase bleeding. Smoking reduces the blood supply that nerves need to heal, so doctors usually strongly encourage stopping as early as possible before elective (planned, non-emergency) repair. Alcohol should also be avoided in the days before surgery.

The following tests are typically ordered to assess your overall health and plan the surgery:

• Blood tests to check general health, clotting ability, and any signs of infection
• Nerve conduction studies (NCS) and electromyography (EMG) — tests that measure the electrical activity of nerves and muscles to map exactly where and how severely the nerve is damaged
• MRI (magnetic resonance imaging) or ultrasound of the affected limb to visualise the nerve and surrounding structures
• X-ray if a bone fracture near the nerve is suspected
• Chest X-ray and heart tracing (EKG) if general anaesthesia is planned

On the day of surgery, the following steps typically take place — though the exact sequence and duration depend on the complexity of your injury:

• 1. You are admitted and the surgical site is marked and prepared.
• 2. The anaesthetist places an intravenous (IV) line in your arm and gives either general anaesthesia (you are completely asleep) or regional anaesthesia (a nerve block that numbs only the arm or hand).
• 3. The surgeon makes a careful incision (cut) to expose the damaged nerve, using the operating microscope throughout.
• 4. The injured ends of the nerve are trimmed back to healthy tissue.
• 5. If the gap is small, the two ends are brought together and sutured (stitched) directly — this is called primary repair.
• 6. If the gap is larger, a nerve graft or a synthetic nerve conduit (a small tube that guides regrowth) is placed to bridge it.
• 7. The wound is closed in layers, and the limb is often placed in a protective splint (a rigid support) to prevent tension on the repair while it heals.
• 8. You are moved to a recovery area to wake from anaesthesia under close monitoring.

Recovery after nerve repair microsurgery is typically long — nerve fibres regrow slowly, roughly one millimetre per day under good conditions, so full recovery can take many months to more than a year. Your progress will be monitored regularly, and rehabilitation is a central part of the process, not an optional extra.

• Hospital stay: Most patients spend at least one night in hospital, though this varies with the extent of the repair and your overall health. You will be monitored for pain, circulation, and wound condition before discharge.
• Splinting and immobilisation: The repaired area is usually kept in a splint or cast for several weeks to protect the delicate sutures and prevent the nerve from being stretched during early healing.
• Wound care: The surgical wound should be kept clean and dry according to the dressing schedule your team provides. Signs of infection — increasing redness, warmth, swelling, or discharge — should be reported promptly.
• Pain management: Nerve pain during regrowth can be intense and sometimes surprising. Your medical team will manage this with appropriate medicines; do not adjust these on your own.
• Hand therapy and physiotherapy: Specialised therapy begins early — sometimes within days — to prevent joint stiffness and muscle wasting (shrinking) while the nerve regrows. This is one of the most important parts of recovery.
• Activity restrictions: Heavy lifting, gripping, or any activity that puts tension on the repair site is usually restricted for several weeks. Your therapist and surgeon will set a graduated return-to-activity plan.
• Sensory re-education: As feeling begins to return (often as a tingling or altered sensation), a therapist will guide you through exercises to retrain the brain to interpret the new signals correctly.
• Follow-up appointments: Regular clinic reviews — including repeat NCS/EMG tests at set intervals — allow the team to track nerve regrowth and adjust your rehabilitation plan.
• Smoking and alcohol: Continuing to avoid smoking is important throughout recovery, as nicotine impairs the blood supply nerves need to regrow. Alcohol in excess can also slow healing.
• Realistic expectations: Some patients regain near-normal function; others have lasting limitations. Your surgeon will give you the most accurate picture based on the type and location of your injury.