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