Repeat microsurgery on tendons and peripheral nerves

When is repeat microsurgery on peripheral nerves and tendons indicated?

Peripheral nerve and tendon damage often leads to serious functional limitations that affect both movement and sensitivity. Modern microsurgery allows for the most effective treatment of such injuries and restoration of function. However, not all cases are successful, and sometimes repeat surgical interventions are required, especially in cases of adhesion formation, neuroma formation, failed nerve regeneration, or compression that develops after surgery. It is in such cases that repeat microsurgical techniques such as neurolysis, tenolysis, nerve grafting and transposition, etc. are used. These techniques reduce pain, improve function and greatly facilitate the patient's rehabilitation.

What types of repeat microsurgical procedures can be performed?

Repeat microsurgical procedures are diverse and serve specific purposes. Their selection depends on the type of complication that developed after the initial surgery, the anatomical integrity of the damaged structure, and the functional goal. The main types of repeat microsurgical procedures are:

• Neurolysis — removal of scar tissue around the nerve to restore its function. This procedure is effective in cases where the nerve is technically intact but its functionality is limited due to scarring.
• Endoneurolysis — a special form of neurolysis in which scar tissue is removed directly from the structures inside the nerve. This procedure is used when the damaged nerve is preserved but scar tissue causes internal compression and prevents impulse transmission or regeneration. It is often used as a repeat operation in cases where external neurolysis is insufficient to restore function.
• Nerve transposition — during surgery, the nerve is moved to a new anatomical location where it is no longer compressed or stretched. Transposition can be performed via submuscular, subcutaneous, or intramuscular access. Its purpose is to protect the nerve from secondary damage, improve function, and reduce pain.
• Nerve wrapping — to prevent the formation  of neuromas or reduce pain after surgery, various biological materials can be used to wrap the nerve (venous membranes, fatty tissue, or synthetic membranes), which reduces sensitivity and pain.
• Tenolysis — involves freeing the tendon from scar tissue.
• Tendon transposition — if the damaged tendon does not heal after the initial surgery, function can be restored by transferring another healthy tendon to the damaged area, which provides partial or complete restoration of lost function.

What are the possible complications associated with repeat microsurgery on tendons and peripheral nerves?

Like all surgical procedures, repeat microsurgery on tendons and nerves carries risks and possible complications, such as:

• Infection;
• Bleeding;
• Recurrence of adhesions;
• Exacerbation of pain;
• Incorrect restoration of sensation or movement.