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Timing and Predictors of Upper Extremity Peripheral Nerve Reconstruction
Kelsey M Gray1, Andrzej J Burkat1, Lucas A Arney2
1Virgina Tech Carilion School of Medicine, Section of Plastic and Reconstructive Surgery, Roanoke, Virginia.
JPRAS Open
|April 24, 2025
Summary
Primary nerve repair is ideal, but tension limits its use. This study identified key factors influencing nerve defect length, aiding surgical planning for optimal nerve reconstruction outcomes.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Regenerative Medicine
Background:
- Primary neurorrhaphy is preferred over nerve grafting for nerve reconstruction, particularly for motor nerves.
- Increased nerve defect length leading to tension is a primary limitation for primary nerve repair.
- Understanding factors influencing nerve defect length is crucial for surgical planning and optimizing reconstruction outcomes.
Purpose of the Study:
- To identify factors influencing nerve defect length in sharp upper extremity nerve transections.
- To compare outcomes of primary repair versus nerve grafting/conduit techniques.
- To develop a predictive tool for estimating nerve deficit and guiding surgical reconstruction choices.
Main Methods:
- Retrospective review of sharp transections of mixed motor and purely sensory nerves in the upper extremity.
- Comparison of primary repair versus nerve graft/conduit groups, analyzing demographics, time to fixation, and tissue gap size.
- Development of a random forest model to identify predictors of nerve defect size, followed by creation of the NERVE calculator.
Main Results:
- Primary repair was associated with a shorter interval from injury to surgical fixation and a smaller tissue gap compared to graft/conduit techniques.
- Optimal timing for primary repair was suggested as within 3 days for mixed nerves and 7 days for sensory nerves.
- Nerve defect size was significantly influenced by days from injury, nerve type, patient age, and hypertension; the NERVE calculator demonstrated high predictive accuracy (R²=0.89).
Conclusions:
- Early surgical intervention within specific timeframes optimizes conditions for primary nerve repair.
- Factors including injury timing, nerve type, age, and hypertension are critical determinants of nerve defect length.
- The developed NERVE calculator provides a valuable tool for surgeons to estimate nerve deficit and inform decisions regarding nerve reconstruction strategies.
