Neurolysis.

Abstract

A proposal for classification of neurolysis and standardization of descriptive terms of neurolysis is made based on the anatomy of the peripheral nerves, particularly the connective tissue layers, the epineurium, the perineurium, and the endoneurium. The techniques of neurolysis are explained. Our animal studies demonstrate that following saline neurolysis, epineurectomy, or interfascicular neurolysis, fibrosis usually occurs in the epineurial layer, regardless of the method of neurolysis used. These findings indicate that neurolysis should be considered only if the scarring in or about the nerve is worse than would be produced by the neurolysis procedure itself. The results of neurolysis for those lesions that have remained in continuity and have failed to recover after an appropriate interval of observation seem to indicate that the procedure is worthwhile in this situation. After review of the literature, we conclude that there is no clinical or experimental series that would give clear guidelines for neurolysis following a repair of loss of continuity of the nerve trunk. With new techniques of nerve stimulation and intraoperative recording, perhaps interfascicular neurolysis will become a more valuable surgical procedure.