Peripheral nerve repair: terminology, questions, and facts

The most important single technical factor in peripheral nerve repair is the coaptation of fascicular tissue. Only an exact description of how coaptation is achieved according to fascicular patterns, can provide the basis for a comparison of results. The problem of preparation of the stumps was discussed, and a method was suggested for defining conditions at different stump levels, in order to indicate to which level the resection should be carried. Demonstrations of the advantages of resecting the epifascicular epineurium, relating to various types of fascicular patterns, were provided. Different factors which contribute to the formation of gaps between nerve stumps were analyzed. Problems related to the sliding capacity of peripheral nerves were discussed, as well as the relationship between sliding capacity and tension distribution along the nerve. A schematic overview of different possibilities for overcoming gaps at the coaptation site was provided. Suggestions were offered for defining the term "neurotization," and different neurolysis procedures were described.