Nerve Injury, Repair and Reconstruction

Peripheral nerve surgery has made several advancements in the last 25 years and is on the threshold of a new era. The gold standard in nerve repair is a primary end-to-end coaptation. Improved understanding of neuroanatomy and topography, the effect of tension causing scarring at the repair site and improvements in suturing techniques have led to better outcomes in motor and sensory recovery. This has also shifted the paradigm to considering reconstructive options rather than performing primary repairs in adverse conditions. Reconstructive options include autograft and allograft nerve grafts, conduits for sensory gaps and nerve transfers. Nerve transfers started as a solution for the 'ungraftable' nerve injury and in many cases have replaced nerve grafting, even when applicable in our practice. The chapter will review the evaluation of nerve injuries and timing of repair based on injury type. We review repair techniques, timing of the repair, preoperative and intraoperative tools to assist in evaluation of the injury as well as the repair options for particular situations and postoperative management.