Timing of peripheral nerve repair: important local neuropathological factors

A review of the local neuropathological factors suggests that in lesions-in-continuity, the timing of surgical intervention should be predicated by the histological structure of that particular lesion-in-continuity. This cannot be derived by inspection or palpation of the lesion. The information must be gained from clinical and electrical studies. In the case of the divided nerve, the interrupted fascicles should be sutured as soon as the longitudinal extent of the injury can be accurately determined. The ultimate factor limiting the successful outcome of delayed peripheral nerve surgery is probably related to the state of the end organs and muscle fibers.