Author Topic: Management of Peripheral Nerve Injury  (Read 366 times)

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Management of Peripheral Nerve Injury
« on: February 22, 2013, 06:39:37 AM »
Management of Peripheral Nerve Injury

The sensory and motor deficits should be accurately documented. Deficits are usually immediate. Progressive deficit suggests a process such as an expanding hematoma, and may need early surgical exploration. Clean, sharp injuries may also benefit from early exploration and reanastomosis. Most other peripheral nerve injuries should be observed. Electromyography and nerve conduction studies (EMG/NCS) should be done 3 to 4 weeks postinjury if deficits persist. Axon segments distal to the site of injury conduct action potentials normally until wallerian degeneration occurs, so EMG/NCS before 3 weeks is not informative. Continue observation if function improves. Explore the nerve surgically if no functional improvement occurs over 3 months. If intraoperative electrical testing reveals conduction across the injury, continue observation. In the absence of conduction, the segment should be resected and end-to-end primary anastomosis attempted. Anastomoses under tension will not heal, so a nerve graft may be needed to bridge the gap between the proximal and distal nerve ends. The sural nerve is often harvested, as it carries only sensory fibers and leaves a minor deficit when harvested. The connective tissue structures of the nerve graft may provide a pathway for effective axonal regrowth across the injury.

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