Surgical treatment of peripheral nerve injuries in upper extremities

This study presents the results of surgical treatment of nerves in upper extremities performed in our clinic over 15 years, from 1985 to 1999. Basic lines of surgical treatment of various injuries of nerves in upper extremities are presented and evaluated in the study. SYNOPSIS AND METHODS: 140 nerves in 123 patients were treated within this period. 95 reconstruction operations were performed by microsurgical technique in 95 patients. All reconstruction surgery was performed in cases characterized by complete and persisting neurological deficit and by the absence of action potentials in relevant nerves. In 42 patients, 45 nerves were reconstructed by an autologous nerve graft. In 53 patients, reconstruction surgery was performed by suture of peripheral nerve that included treatment of 65 nerves. In this group, 10 patients were treated by suturation of 2 nerves and 3 nerves were suturated in one patient. In 28 patients, external neurolysis was the final surgical therapeutic treatment. In this group, neurolysis of 2 nerves was performed in 2 patients. The presence of action potential was always an important criterion in the determination of the type of surgical intervention. The analysis of the effectiveness of surgical intervention was performed with respect to: the period elapsed between injury and operation age of the patient character of injury location of injury category of injured nerve type of surgical intervention

The best results were observed for external neurolysis and for n. medianus. Evaluation of the effectiveness of neural suture did not reveal any significant differences between neural grafts and classical suture. Similar results were obtained for surgical treatment of isolated nerve injuries and for cases involving the reconstruction of more than one nerve. Good or excellent results were typical for early treatment, for distal injuries and for clean incised wounds, especially in young patients.

Early surgical revision combined with neurolysis and reconstruction surgery (if necessary) are crucial factors determining the outcome of operation in indicated cases. With respect to reconstruction operations we did not observe any significant difference between classical suture and suture using nerve graft.