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Conventional Strategies for Nerve Repair

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Modern Concepts of Peripheral Nerve Repair

Abstract

The most used techniques in nerve repair are neurolysis (external and internal), end-to-end neurorrhaphy, and nerve grafting.

The external neurolysis, the resection of constricting tissue surrounding the nerve, is usually performed before almost all types of nerve repair and is seldom used as the treatment itself. Internal neurolysis is the removal of interfascicular scar tissue. This technique is essential in the preparation of the nerve for some other procedures and is indicated in selected cases of posttraumatic neuritic pain with no response to conservative management.

Among the end-to-end neurorrhaphies, the epineurial technique is the most performed and consists in the suturing of the entire nerve trunk as a unit. To minimize the inflammatory reaction, the smallest number of interrupted nylon sutures to maintain alignment of the nerve stumps is used. The perineurial (or fascicular) repair and the grouped fascicular repair are seldom performed.

Nerve grafting is indicated when resection of lengthy lesions results in a large nerve gap, impossible to be overcome without prohibitive tension in the suture line. The nerve grafts serve as guides for the axons of the proximal stump as it grows toward the distal stump. Usually using the sural nerve as a donor nerve, a number of small-caliber nerve grafts are attached between the nerve ends, connecting corresponding groups of fascicles.

Although sometimes presenting good results in selected cases, the techniques of end-to-side neurorrhaphy and direct muscular neurotization are not well established in reconstructive nerve surgery.

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Authors and Affiliations

  1. Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, Rua Virgilio de Carvalho Pinto, 381/apt.42, 05415-030, São Paulo, SP, Brazil

    Mario G. Siqueira MD, PhD & Roberto S. Martins MD, PhD

Authors
  1. Mario G. Siqueira MD, PhD
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  2. Roberto S. Martins MD, PhD
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Correspondence to Mario G. Siqueira MD, PhD .

Editor information

Editors and Affiliations

  1. Hannover Medical School, Institute of Neuroanatomy and Cell Biology, Hannover, Germany

    Kirsten Haastert-Talini

  2. Schriesheim, Germany

    Hans Assmus

  3. Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of Ulm, Günzburg, Bayern, Germany

    Gregor Antoniadis

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Siqueira, M.G., Martins, R.S. (2017). Conventional Strategies for Nerve Repair. In: Haastert-Talini, K., Assmus, H., Antoniadis, G. (eds) Modern Concepts of Peripheral Nerve Repair. Springer, Cham. https://doi.org/10.1007/978-3-319-52319-4_4

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  • DOI: https://doi.org/10.1007/978-3-319-52319-4_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-52318-7

  • Online ISBN: 978-3-319-52319-4

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