The Effect of Surgical Timing on Upper Extremity Nerve Repair

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Regenerative Medicine

Background:

• Peripheral nerve injuries in the upper extremity are common.
• Nerve repair can be primary or require reconstructive techniques like nerve grafting or conduits.
• The optimal timing for nerve repair remains a critical clinical question.

Purpose of the Study:

• To investigate the relationship between the timing of nerve repair and the need for primary repair versus bridge repair.
• To analyze factors influencing the choice between primary nerve repair and reconstructive methods (allograft, autograft, conduit) in upper extremity injuries.

Main Methods:

• Retrospective case-control study analyzing patient data for lacerated upper extremity peripheral nerves.
• Data collected included timing of injury and surgery, demographics, injury characteristics, and repair type.
• Logistic regression was used to assess the odds of requiring bridge repair based on time to surgery.

Main Results:

• A total of 403 nerves across 335 patients were analyzed.
• 162 nerves required bridge repair, compared to 241 primary repairs.
• Longer delays between injury and surgery were significantly associated with increased odds of requiring bridge repair (3% increase per day).
• Bridge repairs were also associated with larger nerve gaps.

Conclusions:

• No definitive critical window for primary nerve repair was identified.
• Significant delays in surgical intervention for nerve injuries are linked to a higher probability of needing more complex bridge repairs.