[Recent injuries of the nerves of the wrist and hand]

The advent of microsurgery has in the last few decades considerably improved the results of treatment of lesions of nerves in the wrist and the hand, both with regard to functional restoration of sensation and movement and to reduction of local irritant factors or those linked to cold injury. Peripheral nerves are frequently injured at the wrist and the hand by contusion, compression, straining or total or partial section. In the case of wrist, hand or finger wound, only well-directed, precise and systematic clinical examination can determine the neurological deficit. Surgery is always indicated. There are often associated complex lesions, and all injured elements must be completely repaired. The order of this repair is always the same: tendons, nerves, then vessels. Concerning nerves, therapy depends on the severity of the contusion and (or) the loss of substance. If the section is distinct, direct suture with physiological tension can be made. On the other hand, if there is contusion or loss of substance, direct suture cannot be performed since nonphysiological tension leads to endoneural ischaemia and fibrosis. Rather, the extremities should be brought closer together in order to avoid retraction and subsequent secondary sutures or short grafts should be made.