Microsurgical Repair of Peripheral Nerve Lesions: A Study of 150 Injuries of the Median and Ulnar Nerves

Abstract

Since 1964 microsurgical techniques have found increasing use for repair of severed peripheral nerves (Michon 1964; Michon et al. 1977; Michon and Möberg 1979; Smith 1964). However, as recently as 1958, Gosset expressed an attitude toward these injuries typical of those times; “Early or delayed repair of divided nerves has a poor prognosis” and “sutures and grafts often fail.” In 1967 and 1976 Millesi et al. emphasized the detrimental role of tension at the repair site and advocated the use of interfascicular nerve grafts using microsurgical techniques whenever tension was a problem, as did Samii and Scheinpflug (1974). Over the past 20 years, a variety of experimental and clinical studies have been reported with a wide disparity of results. In many of the studies small series were examined; many different surgeons treated the patients, and rigorous postoperative evaluation or assessment was not always carried out. It is therefore difficult to define realistic postoperative expectations. Indeed, one could be erroneously convinced that a secondary repair is preferable to a primary repair, and that a fascicular nerve graft should be preferred to a direct suture.