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PubMed1993

[Peripheral nerve injuries--current treatment standard].

A review of our century's efforts to overcome nerve defects reveals the conclusion that today microsurgical techniques and interfascicular nerve grafting offer the best chances to get success in peripheral nerve repair. There exists a theoretical grading system of Sunderland, which enables us to understand the very different factors which might influence the sprouting of nerve fibers within the damaged or repaired nerve segments. But in practice, the indication to operate always depends on our own decision. The neurological status and electrophysiological tests can only sometimes facilitate our treatment and judgement on peripheral nerve lesions. The basic principles of microsurgical nerve repair are still valid. Modern techniques have resulted in better prognosis. Vast mobilization to achieve neurorrhaphy by force is obsolete today. Epineural trunk-to-trunk-suture is only allowed after clean cut-injuries. In all other cases we have to prefer a repair by autologous grafting. But some factors still remain which limits our efforts, such as muscle degeneration depending on time interval or ischemic fibrosis after the lesion, direct trauma to the muscle substance or a lesion in the region of nerve ramifications.

Humans↗
PubMed1988

Update on peripheral nerve injuries.

Experimental work relating to factors affecting nerve regeneration is reviewed. There is increasing evidence that the nerve sprouts are preprogrammed for their peripheral reinnervation; old endoneurial tubes being discarded. Fascicular suture shows no significant improvement in function compared with epineural suture. The importance for sensory re-education and the need for repeatable sensory function tests is emphasized. Recent experimental work on the mechanisms of causalgia is reviewed and management of painful peripheral nerve disorders discussed. Striking advances have been made in the diagnosis, surgical treatment and rehabilitation of traction lesions of the brachial plexus. These are discussed with special reference to electrodiagnosis, functional splinting and management of pain. Surgery for obstetric palsies is now being undertaken and similar lesions to those in the adult being repaired with success. Reconstructive procedures for permanent paralysis are reviewed. Postirradiation plexus lesions present a formidable challenge but surgery can sometimes alleviate pain.

Brachial Plexus↗
PubMed1986

Acute management of peripheral nerve injuries.

Acute management includes physical examination at the time of injury as a baseline for more detailed evaluations of motor and sensory function. The decision regarding type of nerve suture is based on the extent of the extremity wound and the cause of injury. In the closed extremity injury, spontaneous nerve recovery can be correlated with cause of injury. The evaluation of clinical recovery is based on nerve return and extremity coordination.

Arm Injuries↗
PubMed2000

Anatomy and physiology of peripheral nerve injury and repair.

The management of peripheral nerve injury continues to be a major clinical challenge. Despite advancements in microsurgical technique, results after nerve repair have been unpredictable and dis appointing. The management of these nerve injuries relies on having a thorough understanding of peripheral nerve anatomy. This is the basis of the classification schemes by Seddon and Sunderland, in which the prognosis of nerve injuries varies depending on the degree of injury to their substructures. The most recent advances in the management of peripheral nerve injuries rely on the ability to manipulate the pathophysiologic processes triggered by nerve injuries and regeneration. End-to-end primary repair should be sought whenever a tension-free repair can be attained. If there is a significant nerve gap, use of nerve autograft remains the gold standard. In nerve injuries where a nerve autograft is not possible, the use of nerve allograft, as well as autogenous, biodegradable, and synthetic nerve conduits has shown promising results in experimental studies.

Humans↗
PubMed1985

Selected recent advances in peripheral nerve injury research.

Interactions between Schwann cells and growing neurites are reviewed as are the implications of axonal transport studies in shaping the regenerative process. Increased investigative attention will be required to study biochemical changes occurring in the local environment of the injury site even though continued study of the neuronal metabolic process remains critical. Important studies concerning the connective tissue structure of nerve and probable "blood-nerve barrier" sites are reviewed. Factors responsible for connective tissue proliferation and fibroblast alignment after injury are not well understood. Recent experimental studies relating to surgical repair of nerve are reviewed as are a few selected papers reflecting changes in clinical management of the patient with nerve injury.

Axonal Transport↗