ABSTRACT
The management of nerve injuries poses special difficulties for the surgeon. Although the majority heal satisfactorily without surgical intervention, a year may pass before it is evident that a particular injured nerve will not heal on its own. By then, it is too late to do a nerve repair (‘‘neurorrhaphy’’) and have this followed by a satisfactory motor recovery. To obtain a good result from neurorrhaphy, it must be performed within six months after injury. On the other hand, the result obtained from carrying out a timely neurorrhaphy is not as good as the result from spontaneous recovery. Neurorrhaphy is to be avoided unless clearly indicated; often this decision must be made before a spontaneous recovery is evident from changes in the neurologic examination. This chapter addresses the pathophysiology of nerve injury and the physiologic basis of nerve repair. It also provides a strategy for the timely identification of nerve lesions that require operative intervention. To accomplish these goals, we only consider mechanical trauma to large mixed (motor and sensory) nerves.
