For This Peripheral Nerve Lesion, It Is Best to Avoid the Knife

Abstract

Peripheral nerve injury (PNI) is a common affliction for which there are few effective treatment options. PNI, including root avulsions, occurs in 2%–5% of all trauma cases in the United States, including assaults and motor vehicle accidents, and a significant proportion of warfighter injuries involve peripheral nerves (Wang et al., 2017; Robinson, 2000; Pfister et al., 2011). PNIs that do not result in damage to overall nerve structure, such as crush or stretch injuries, generally result in a wait-and-see approach to determine if function returns spontaneously (Ali et al., 2014, 2015; Zager, 2014). However, PNI resulting from a nerve transection requires a surgical procedure to reconnect the proximal and distal nerve stumps directly (if possible) or by inserting a biological or synthetic bridging graft between them (Pfister et al., 2011). Overall, in cases requiring surgical intervention, outcomes of surgical repair for traumatic PNI are generally unsatisfactory as only 50% of patients achieve good to normal restoration of function, irrespective of repair strategy or injury location (Ruijs et al., 2005).