Lower Limb Surgery

Lower Limb Limb Limb Surgery

Nerve Transfer


A nerve transfer is a surgical procedure that can be used to restore movement and feeling in limbs. It is commonly used when a patient has a nerve injury that causes a complete loss of movement or sensation. Nerve transfers involve taking nerves with less important roles and transferring them to restore function in the nerve that has been severely damaged or injured.

About Nerve Injuries

Nerve injuries are most common in the upper (hand and arm) and lower (leg) extremities. These can be caused by either blunt trauma, such as an impact from a fall or from traction injuries from motor vehicle accidents, or sharp trauma, such as occurs from a direct cut from a knife. In either case, significant nerve injuries require expert evaluation and treatment. In some cases, where the nerve remains partly intact, careful observation and time may be all that is required to achieve recovery. However, in many instances, these injuries will require surgical reconstruction.

Surgical Repair

Surgical nerve repair involves the exploration of the injured nerve and the removal of injured tissue or scar from the nerve endings. After that, a nerve can be directly reconnected if there is enough length on the ends to allow for a good-quality repair without tension. Repairs are performed with the assistance of an operating microscope to allow for the best alignment of the fiber bundles, called fascicles, inside of the injured nerve. In some cases when a larger amount of tissue has to be removed from the nerve endings, there is too large a gap to allow for direct repair. In those cases, a non-essential nerve will be sacrificed from a separate location on the body (usually from the leg or upper arm) and used to bridge the nerve gap. This procedure is known as nerve grafting. Other approaches for repair such as a conduit, and an artificial tube connecting the nerve endings, may be used in particular circumstances when grafts are not possible. Nerve graft substitutes, derived from donated nerve tissues, are also appropriate instead of nerve grafting for some patients.

Tendon Transfer


Tendon transfers are often used to restore movement in limbs. In this procedure, a muscle that the patient still has control of but that performs a non-critical function is repositioned to perform a critical but missing function.

After this procedure is performed there is a period of immobilization where the limb is placed in a splint followed by early physical therapy. The recovered movement is available almost immediately, but the limb must be treated with care for at least 6 weeks following the operation. This procedure can be performed late after the nerve injury if a local transferrable muscle is available.

What are the alternatives to Tendon Transfer Surgery?

You can discuss other treatment choices with your hand surgeon. Other options may include repairing the nerve that has been injured or repairing the tendon or muscle that has been injured. In some cases, tendon grafts can be used, in which a portion of the intact tendon is removed, without its muscle, and used to bridge a gap in an injured tendon. In other cases, tendon lengthening or bone fusions may be necessary as part of reconstructing hand function.

What happens during Tendon Transfer Surgery?

Below the elbow, there are over forty muscles. Each different muscle has a different function. For example, there are 9 muscles that move the thumb. Each muscle has a starting point (origin), and tapers down from its muscle belly into a tendon that then attaches onto bone (insertion) in a specific place; when the muscle fires (contracts), it causes a certain motion (action).

During tendon transfer surgery, the origin of the muscle is left in place; the nerve supply and blood supply to the muscle is left in place. The tendon insertion onto bone is detached and re-sewn into a different place. It can be sewn into a different bone, or it can be sewn into a different tendon. After its insertion has been moved, when the muscle fires, it will produce a different action, depending on where it has been inserted.

Limb Replants


Limb replantation is a complex microsurgical procedure that allows patients to have severed limbs reattached or “replanted” to their bodies. Most patients need limb replantation within hours of experiencing traumatic injuries.

Depending on the type of injury you have, surgical specialists can replant some severed limbs. Replantation is more common for upper extremities like arms, hands, and fingers. It is less common for the lower extremities.

While replantation is usually more successful with sharp injuries, some types of crush injuries do respond successfully.


Replantation is a surgical procedure where amputated body parts are reattached to the body. To perform replantation, surgeons often repair injured bony structures as well as tendons, blood vessels, nerves, and skin. Surgeons may also need to repair additional soft tissue coverage. For all replantation procedures, patients must be admitted to the hospital for post-operative monitoring.

Immediately after your injury, our team of specialized surgeons will examine your injury to determine where damage has occurred to your skin, bones, nerves, blood vessels, muscles, and tendons. Surgeons will then rapidly develop a treatment plan to restore blood flow, repair damaged nerves and bones, and—if needed—repair damaged skin using flaps or skin grafts.

In many cases, plastic surgery, performed together with orthopedic and vascular surgery, can restore substantial function to severely injured limbs.

Our team of specialized hand surgeons works closely with hand therapists to optimize patients’ recovery times and to restore function after surgery.