Traumatic Nerve Injuries

Abstract

Traumatic nerve injuries range from blunt force contusions causing temporary numbness to complete destruction of major nerves with permanent functional loss. The type and extent of injury, as well as the specific nerve(s) involved, determine the potential functional threat to the patient. A thorough clinical evaluation, along with judicious use of ancillary tests, guides treatment. Most closed nerve injuries are best initially observed to allow for spontaneous recovery. In some closed cases, neurolysis can facilitate distal axon progression. Other closed cases ultimately prove higher grade and require more complex reconstruction. Most lacerative nerve injuries should be taken emergently to the operating room for direct repair before gap formation. In the absence of excess tension, acute lacerations may simply be sutured back together under a high-magnification surgical microscope. Once separated over time, the two nerve ends retract, swell, and fibrose, creating a gap that must undergo reconstruction. Short nerve gaps can be bridged with cadaveric processed nerve allografts. Longer gaps targeting motor receptors may require autogenous cable nerve grafts harvested from the patient. Nerve and tendon transfers are final options.