The Metabolic Background for Peripheral Nerve Surgery

Abstract

HE proper time to repair a severed peripheral nerve continues to be debated. The response to traumatic nerve sectioning and the recovery after a neurorrhaphy varies greatly from nerve to nerve and with different levels of the same nerve. Earlier guidelines have now become clouded. Some recent textbooks and articles avoid any explicit instructions concerning the timing of a repair; ~ others advocate immediate repair; 1~7,27,41,47,52 still others hold out for a short 2 to 3 week delay; 12,36,5~,59,71,73 and, finally, some state it makes no difference? ~ The policy within the medical service of the Army has been that nerve suture should be done as soon as possible after a short waiting period of 2 to 3 weeks. This conclusion is based on articles written after World War II, which were concerned mostly with allowing peripheral demarcation of a war wound, and which were clinically supported by evaluation of motor return of function) a,54,56,71,72 Delays beyond the initial 19 to 21 day waiting period were accompanied by a 1% reduction in motor recovery for every 6 days of postponement of the definitive neurorrhaphy. 72 For the moderate size nerves such as the median, ulnar, radial, peroneal, and tibial, these guidelines hold true. For large nerve trunks, such as the sciatic nerve or brachial plexus, regardless of the timing of a repair, the outlook remains poor. For the smaller digital nerves, any delay appears unnecessary, and the progno