Reconstructive Surgery of the Peripheral Nerves

The reconstructive surgery of the peripheral nerves addresses patients undergoing trauma involving different peripheral nerves (median, ulnar, radial, sciatic etc). If the nerve has been damaged over 6 months prior to the intervention, the reconstructive surgery can not restore full functionality. The paresis and paralysis that sets in after the peripheral nerve's trauma may be final if the period exceeds 24 months.

Depending on the complexity of the injury, a decision is made for the urgent, delayed urgent (a few days after the injury) or secondary (a variable interval between 2 and 4 months) treatment of all the traumatized elements. Nerve repair is done by microsurgical suture under magnification and requires splint immobilization in a cast for at least 3 weeks in order for the nerve suture to scar.

If the nerve repair is secondary and the damaged nerve ends were anchored in emergency or if there are significant defects of the nerve substance, there is a need of using nerve grafts, namely using fragments of other nerves with lesser importance in the overall economy of the body, in order to restore continuity to the damaged nerve. 

The restoration of the nerve path often takes more than three weeks, may last even a few months, as the injured nerve recovers at a rate of 1mm/day.

Common causes of nerve injuries are:

  • road or rail accidents
  • accidental cuts (glass, knife, sword etc)
  • large bone fractures, orthopedic or surgical (radial nerve lesion)
  • work injuries using electric shearing machinery (flex, jointer, circular etc).
  • important bruises or tears afecting all structures of the injured segment. In this case there is the increased risk of compartment syndrome, and even if there is no solution of skin continuity,
  • the correct therapeutic attitude is to open all the skin and muscle fascia in order to avoid the internal compression of the noble tissues (muscles, vessels, nerves).

In case of an injury originated more than six months prior, if the lesion is peripheral and relying on electric investigations, we can try to revive the nerv. If this attempt fails, then we can choose a palliative method for partial recovery of the functionality in the affected segment.

 Results depend largely on the type of injury, its severity and the time since its appearance.

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