[Restoring the continuity of severed peripheral nerves. Indications and surgical technics]

The detailed literature is critically examined, especially with regard to the questions of the time of the operation, technique of the intervention, use of transplantation, suture under tension, etc. The author recommends the following operating tactics: (I) Smoothly separated nerves without any defects or larger side-injuries are subject to primary care. Mono- to oligofascicular nerves are loosely coapted by epineural sutures; the protruding contents are not excised. For polyfascicular nerves one uses endofascicular guiding sutures and coaptation by epineural sutures. In case of a clear group structure, interfascicular coaption is used. (2) Early secondary care according to plan gets to the stumps from the healthy material and uses interfascicular transplantation for every tension occurring. In case of polyfascicular nerves without group structure, the corresponding sectors are connected with each other. (3) The late secondary care follows the rules for the early secondary care. (4) Re-operations are carried out if regeneration does not set in, testing is mainly carried out by means of the Hoffmann-Tinel sign. Sometimes intraneural neurolysis will be sufficient in these cases; more often than not, parts of the whole cross-section must be resected or bridged again by transplantation.