Mini-symposium from the Asia Pacific region
(iii) Peripheral nerve repair

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Abstract

Peripheral nerve injuries affect all age groups and can be devastating to patients. A timely repair and thorough exam both preoperatively and intraoperatively can help increase the chances of a successful outcome. The technical aspects of peripheral nerve injury evaluation and repair must take into account the unique anatomy and function of the nervous system. Proper microsurgical techniques such as tension-free repair are a critical aspect of the repair process. Nerve grafts, conduits, and biotherapies are all viable ways to increase the odds of a meaningful repair. Proper immobilization, mobilization, and a targeted rehabilitation protocol are also important.

Section snippets

Anatomy & physiology

The neuron is the fundamental building block of the central and peripheral nervous system (Figure 1). Its distinctive structure equips it to send and receive signals from target organs that lie physically far from the brain. Transportation of the action potential of the neuron begins at the cell body or perikaryon and extends down the long narrow projection of the cell called the axon. At the end of the axon is the synapse, which is the means by which nerve cells project signals to target

Classification

Nerve injuries can be roughly classified as either temporary (neurapraxia, axonotmesis) or permanent (neurotmesis). Seddon first advocated this classification in 1948, which was modified a few years later by Sunderland.11 A Sunderland First Degree Injury corresponds to a neurapraxia, meaning a partial disruption in conduction at the site of injury. However, since the basic structure of the axon is preserved, Wallerian degeneration does not occur. Compression neuropathies such as carpal tunnel

Evaluation and surgical repair

The decision to repair a nerve takes into account both the condition of the nerve and the capabilities of the operating team. Nerve exploration and repair is indicated in the following settings: paralysis associated with a wound in the vicinity of a nerve; a closed injury with soft tissue damage; an open injury requiring open reduction and internal fixation.1 Other indications include nerve lesions with arterial injury, traction injuries to the brachial plexus, declining nerve function under

Recovery and rehabilitation

Postoperatively, tension must be taken off the repair by splinting the extremity in an appropriate position for 2–3 weeks. In the case of repair at or near the wrist, a dorsal blocking splint is then applied for 3 more weeks.30

The likelihood of a successful recovery depends on several factors, both in the patient and during surgery. According to several studies, patient age and time elapsed between injury and repair are the most important factors in prognosis. A delay in repair of 6 days

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