Primary peripheral nerve repair in the hand and upper extremity

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Traumatology

Background:

• Nerve injuries from civilian trauma present unique challenges for surgical repair.
• Optimizing functional recovery after nerve lacerations is a key clinical goal.
• The comparative efficacy of primary versus secondary nerve repair remains an area of investigation.

Purpose of the Study:

• To evaluate the functional outcomes of primary nerve repair in civilian injuries.
• To compare the results of primary nerve repair with secondary repair for mixed nerve injuries.
• To determine the optimal surgical approach for maximizing nerve regeneration and functional recovery.

Main Methods:

• A consecutive series of primary nerve repairs for civilian injuries were analyzed.
• Functional outcomes, including two-point discrimination, stereognosis, and motor return, were assessed.
• A subset of 15 patients undergoing delayed (secondary) repair of mixed nerve lacerations were included for comparison.

Main Results:

• Primary nerve repair resulted in anticipated normal two-point discrimination and stereognosis in both digital and mixed sensory-motor nerve injuries.
• Motor return approached normal levels in the majority of patients following primary repair.
• Secondary repair yielded significantly poorer outcomes, with no return to normal sensory function and limited motor recovery (graded ≤3/4).

Conclusions:

• Primary nerve repair is demonstrably superior to secondary repair for civilian nerve injuries.
• Early surgical intervention and thorough debridement can render most civilian nerve injuries suitable for primary repair.
• Optimizing surgical timing is crucial for achieving the best possible functional outcomes after nerve trauma.