Clinical Nerve Repair And Grafting

Abstract

The results of median and ulnar nerve repair and grafting indicate that 1) Age is the primary determinant of outcome after neural repair or grafting, 2) The proximo-distal level of injury influences motor but not sensory recovery, 3) Delay in repair adversely affects outcome, 4) Functional recovery decreases as the severity of injury to the nerve increases, 5) The use of the operating microscope and microsutures improves the results of nerve repair, 6) Functional restoration after nerve grafting deteriorates as graft length increases, and 7) The outcome of nerve grafting is equal to that of nerve repair in distal nerves that serve a single function. Including additional nerves in the analysis revealed that false sensory localization after median nerve repair and synkinesis after facial nerve repair suggest the absence of topographic specificity in both sensory and motor regeneration. Many of these clinical findings can be restated biologically in terms of intraneural organization, the effects of denervation time on regeneration, and age-related changes in gene expression. This restatement facilitates the design of strategies to improve the persistently disappointing results of nerve repair and grafting.