Microsurgical nerve repair, nerve grafting and brachial plexus surgery — restoring movement and sensation after nerve injuries from trauma, birth or disease.
Peripheral nerve injuries — from trauma, birth injuries or tumour compression — cause loss of motor function (paralysis) and sensation. Nerve regeneration is possible but requires the nerve ends to be correctly aligned and repaired. Dr. Thusay's fellowship in Microsurgery, Nerve and Hand Surgery in Bern, Switzerland, provides specialised training in the full spectrum of nerve reconstruction — from simple primary nerve suture to complex brachial plexus reconstruction with nerve grafts and nerve transfers.
Detailed neurological examination to map the pattern of weakness and sensory loss. Nerve conduction studies (NCS) and EMG to assess nerve and muscle function.
MRI neurography or ultrasound to identify the site and extent of nerve injury and assess for neuroma formation.
Primary repair: within 48–72 hours of a clean nerve laceration. Nerve grafting: 3–6 weeks for zone preparation. Brachial plexus: 3–6 months post-injury.
Nerve ends prepared under magnification. Direct suture (9-0 or 10-0 monofilament) or interposition graft placed. Nerve transfers designed to reinnervate priority muscles.
Nerve regenerates at approximately 1 mm/day. Return of motor function may take 3–18 months depending on injury level. Hand therapy is essential throughout.
Nerves regenerate at approximately 1 mm per day (roughly 2.5–3 cm per month). The time to functional recovery therefore depends on the distance from the repair site to the target muscle — which can be many months to over a year for proximal injuries.
Not always — if the nerve has been severely crushed, the muscle it supplies has been without innervation for too long (typically >12–18 months), or the nerve is too badly scarred, direct repair or grafting may not be feasible. In these cases, nerve transfer, tendon transfer or free functional muscle transfer are considered.
Carpal tunnel syndrome is caused by compression of the median nerve at the wrist. Carpal tunnel release involves cutting the transverse carpal ligament to decompress the nerve — a safe, quick procedure done under local anaesthesia with near-complete recovery of symptoms.
Erb's palsy is a brachial plexus birth injury (BPBI) — injury to the upper roots (C5–C6) of the brachial plexus during delivery, causing weakness of shoulder abduction and elbow flexion (the 'waiter's tip' position). Early assessment and microsurgical reconstruction in the first year of life optimise outcomes.
Results depend on the type, level and age of the injury, and the time elapsed before repair. Young patients with sharp injuries repaired promptly have the best outcomes. Realistic goals are discussed at the consultation — Dr. Thusay prioritises honest expectation-setting.
Essential. Physiotherapy and occupational therapy maintain joint mobility, prevent contracture formation and guide sensory re-education as nerve function returns. Dr. Thusay coordinates care with specialist therapists throughout recovery.
A nerve graft bridges the gap between injured nerve ends. The most commonly used donor nerve is the sural nerve from the back of the leg — a sensory nerve whose harvest leaves only minor numbness on the outer foot. Processed nerve allografts (from donors) are also available and avoid donor site surgery.
Facial nerve paralysis from trauma, tumour or Bell's palsy may require nerve grafting, cross-face nerve grafting or free muscle transfer for smile restoration. Dr. Thusay assesses each case individually.
Dr. Pranav Thusay will personally assess your case and create a tailored plan.