Chapter 2 - History of Peripheral Nerve Repair

Abstract

The history of peripheral nerve surgery can be divided into three distinct phases. Prior to the nineteenth century, surgeons possessed a very limited understanding of the anatomical and physiological nature of nerves. During the nineteenth century, the field struggled with contrary beliefs about how best to heal nerves following injury, leading to a lack of real surgical treatment, and in the twentieth century, general surgeons, neurological surgeons, and plastic surgeons rapidly advanced the practice of peripheral nerve repair. Peripheral nerve surgery began with a growing understanding of the structure and function of nerve tissue, and its current state of sophistication arose as a result of a much deeper understanding obtained through technological advances. Many developments in the treatment of nerve injury came about through the exigencies of war, during which thousands of victims of various conflicts contributed their conditions for the study and treatment of peripheral nerve injuries. Throughout its history, the field has worked to determine the classification of nerve injuries, whether these injuries should be operated upon or not, which procedure should be undertaken if operation is decided on, which techniques were best for nerve suture if undertaken, how to deal with nerve gaps if they are too large for direct suture, and timing of surgery. Some of the best neuroscientists and surgeons of the past few centuries dedicated themselves to answering these questions in their goal of helping patients with these potentially devastating injuries. As a result, the outlook of today’s patient is vastly different from those of past centuries.