Three Useful Tips and Tricks for Intraoperative Nerve Stimulation

Wen-Chih Liu; Floris V Raasveld; Maximilian Mayrhofer-Schmid; Kyle R Eberlin; Ian L Valerio

doi:10.1097/GOX.0000000000005640

Three Useful Tips and Tricks for Intraoperative Nerve Stimulation

Plast Reconstr Surg Glob Open. 2024 Mar 8;12(3):e5640. doi: 10.1097/GOX.0000000000005640. eCollection 2024 Mar.

Authors

Wen-Chih Liu^{1

2}, Floris V Raasveld^{1

3}, Maximilian Mayrhofer-Schmid^{1

4}, Kyle R Eberlin⁵, Ian L Valerio⁵

Affiliations

¹ From the Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
² Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
⁴ Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany.
⁵ Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

Abstract

Disposable handheld nerve stimulators are widely used in peripheral nerve surgery. Such devices stimulate a motor nerve or the motor component of a mixed nerve by applying electrical current to the proximal region, targeting the main nerve trunk. This stimulation then travels along the motor nerve, reaching the distal end to control the corresponding muscle(s). In this study, the authors demonstrate three useful tips and tricks for handheld nerve stimulation during targeted muscle reinnervation and peripheral nerve surgery. The three tips are (1) identification of proximal muscle contraction by retrograde electrical stimulation of a distal sensory nerve; (2) graded stimulation for identifying motor nerves within fibrotic scarred tissue beds or parallel to the major motor/mixed nerve of interest; and (3) proximal stimulation for validation of adequate post-targeted muscle reinnervation coaptation(s).