Three Useful Tips and Tricks for Intraoperative Nerve Stimulation.

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).
Competing Interests: Dr. Eberlin is a consultant for AxoGen Inc, Checkpoint Surgical Inc, Integra Lifesciences Inc, Tissium, Tulavi Therapeutics Inc, and Biocircuit. Dr. Valerio is a consultant for AxoGen Inc, Checkpoint Surgical Inc, and Integra Lifesciences Inc. All the other authors have no financial interest to declare in relation to the content of this article. This work was supported in part by the Jesse B. Jupiter Research Fund/Wyss Medical Foundation. Disclosure statements are at the end of this article, following the correspondence information.
(Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)