Surgery of Peripheral Nerves

Abstract

Because trauma is responsible for most peripheral nerve injuries, it is understandable that times of war have produced much of the knowledge upon which the principles of peripheral nerve surgery are based. Since peripheral nerve injuries are not life threatening, other system injuries are usually of primary concern. Once the cardiorespiratory condition of the patient is stabilized, attention may then be directed to compound extremity injuries. Prior to any operative debridement, a careful examination should be done to ascertain the extent of neurologic dysfunction. At the time of initial surgery, the nerve injury is inspected and described as to its nature, location, and severity. Surgical repair of the nerve is deferred at the time of initial surgery if the wound is contaminated; today’s improved surgical technique with aseptic and antiseptic measures has not decreased the risk of an apparently “clean” wound becoming infected with extensive secondary loss of tissue, making reconstructive surgery even more difficult. Separated nerve ends may be tagged with radiopaque sutures to aid localization at the time of a delayed neurorrhaphy.