Nerve Repair

Peripheral nerve trauma in the upper limb may result both in sensory and motor deficits of the hand, reducing the patient's
fitness. This frequently results in hindrance or even prevention from performance of simple daily and professional tasks. The nerve is usually damaged as a result of a limb injury. Failure to implement proper treatment at the early post-traumatic stage may result in irreversible atrophy of entire muscle groups. A nerve injury can also result in development of a painful neuroma. Selection of the treatment method depends on the time that elapsed from the injury, its degree and extensiveness. Other factors having effect on the final result include also age and concomitant diseases. The best treatment results are achieved in case of immediate repair of the damaged nerve by sewing the stumps. The longer the period of time from the injury to reconstruction, the lower the changes to achieve satisfactory results. If a large fragment of the nerve is destroyed, its reconstruction is carried out using the patient's nerve graft.

Nerve reconstruction is a particularly complex and sometimes multi-staged process. It requires knowledge and rich experience in the scope of microsurgical techniques. Specialistic tools and a surgical microscope are also necessary. It must be noted that treatment of neural injuries, especially old cases and with a concomitant extensive injury to the surrounding tissues, is a process characterised with an end result that is difficult to predict. Reconstruction of nerve continuity by fixation of its ends is to ensure only proper conditions for its spontaneous regeneration. Literature shows that the rate of this process is ca. 1 mm per day in healthy young patients. It may so happen that there will no regeneration attempt on the part of the nerve fibres even if the fixation was performed perfectly. In such cases, only a partial sensory or motor function improvement is noticeable. Sometimes, there is no improvement at all.

It must be emphasised that the final result of even a perfectly conducted surgical treatment depends to a great extent on the post-operative rehabilitation of the upper limb operated on. It is also essential to implement a proper physiotherapeutic programme after the very injury to inhibit muscular atrophy and for prophylactic purposes in terms of hand contractures. Determination of the treatment method and expected results is possible only after a detailed physical examination of the injured hand and familiarisation with the supplied medical documentation. The patient is asked to supply all documentation (including imaging and electrodiagnostic examinations) related to the injury and potential therapy. It may be necessary to carry out new imaging examinations of the hand (ultrasound, X-ray, MRI) and electrodiagnostic tests of the peripheral nerves (EMG).

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