Clinical Areas
Peripheral Nerve & Brachial Plexus Surgery
Peripheral nerves carry movement signals from the brain and spinal cord to the muscles, and sensation from the skin and tissues in the opposite direction. When a nerve is injured — cut, stretched, or compressed — the result may be weakness or paralysis of specific muscles, numbness and loss of sensation, neuropathic pain, or a muscle imbalance that leads over time to secondary deformity.
Peripheral nerve surgery aims to restore movement or sensation, or to relieve selected nerve-related symptoms, where this is possible — through nerve decompression, repair, grafting, or transfer, or through secondary functional reconstruction.
Care is led by Dr. Khalid Almutairi, a consultant plastic surgeon who is board certified in plastic and reconstructive surgery and fellowship trained in hand surgery and microsurgery in Canada and the USA.
How is a nerve injury assessed?
Assessment begins with understanding the mechanism, level, and timing of the injury, careful examination of movement and sensation to determine whether the deficit is complete or partial, and monitoring for signs of spontaneous recovery. Investigations may be requested where indicated — such as ultrasound, MRI, or electrodiagnostic studies (nerve conduction studies and EMG) — without every test being necessary for every patient.
Timing matters in a particular way: a regenerating nerve grows slowly and must reach its target muscle before the muscle loses its ability to be reinnervated. Persistent weakness or numbness after an injury should therefore be assessed without delay — although decisions rest on individual evaluation rather than rigid time cut-offs.
The toolbox: from direct repair to functional reconstruction
There is no single operation for every nerve injury; there is a set of tools from which the appropriate option is chosen for each case:
- Nerve decompression: as in carpal tunnel syndrome or ulnar nerve compression.
- Direct nerve repair: suturing the ends of a divided nerve under magnification when they can be approximated without harmful tension.
- Nerve grafting: bridging a gap between nerve ends when distance prevents tension-free direct repair.
- Nerve transfer: redirecting a functioning but expendable nerve or branch to a more important injured nerve, shortening the regeneration distance to the muscle.
- Tendon transfer: using a well-functioning muscle to perform a movement permanently lost through nerve injury.
- Free functional muscle transfer: transferring an entire muscle with its vessels and nerve by microsurgery, in selected cases of long-standing paralysis.
Why nerve recovery differs from wound healing
A healed wound does not mean restored function. A repaired nerve does not work immediately; its fibres regenerate gradually toward their target over months. The degree of recovery depends on the level of injury, the distance to the muscle, the patient's age, and the timing of treatment. Full return of movement or sensation cannot be guaranteed, and realistic expectations for each case are discussed frankly before any decision.
Brachial plexus injuries
The brachial plexus is the network of nerves that carries movement and sensation between the spinal cord and the upper limb. Severe injury may cause weakness or paralysis affecting the shoulder, elbow, and hand. In severe injuries, reconstruction usually prioritises the most useful movements — such as shoulder stability and elbow flexion — rather than attempting to reproduce every lost function, and the exact priorities differ between patients.
Birth-related brachial plexus injury in infants is distinguished from adult traumatic injury; each follows a different pathway of assessment and follow-up, and every case is evaluated individually.
Rehabilitation and motor retraining
Physiotherapy and occupational therapy are a core part of the recovery journey: keeping joints supple while awaiting nerve regeneration, then retraining the brain to use a muscle after a nerve or tendon transfer. Programmes differ by case, and individual instructions are the reference.
What is offered routinely, and what is assessed individually
Consultations for the assessment of nerve injuries are offered routinely. Complex reconstructive procedures — such as brachial plexus surgery and free functional muscle transfer — are evaluated case by case, and the appropriate pathway and treating facility are determined according to the individual circumstances and facility requirements.
Medical-information notice
This information is general and does not constitute a diagnosis or individual medical advice. It does not replace consultation, discharge instructions, or patient-specific follow-up advice. Urgent medical conditions require emergency services.