New Insights and Applications in the Treatment of Nerve Injuries

Abstract

Peripheral nerve injuries can have devastating functional consequences. Particularly in the pediatric population, nerve injuries may have negative implications on growth, mobility, and quality of life of children. Historically, treatment of peripheral nerve injuries had limited application and suboptimal results. While the advancement of microsurgical technique as well as our understanding of nerve injury and regeneration has led to improved technical ability to repair nerve pathology, the slow rate of neuroregeneration has limited the results of treatment of proximal nerve injury. Previous decades of work have helped shape the novel concept of treating proximal peripheral nerve injuries with a distal reconstruction via nerve transfers. Injuries that are far from the end target can be managed more efficaciously by converting them to a distal reconstruction, by borrowing expendable nerves to reestablish critical function. This not only speeds reinnervation, thereby preserving motor end plates and improving function, but also allows reconstruction of previously untreatable lesions or those that have a delayed presentation. This chapter reviews special considerations specific to nerve injury in the pediatric population, the mechanisms of neuroregeneration, obstacles in muscular reinnervation after injury, and modern approaches to the treatment of peripheral nerve injuries in children.