Median nerve: Acute repair of laceration
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Primary repair of an acute peripheral nerve laceration is a common procedure, performed by orthopaedic surgeons, plastic surgeons and others. A good outcome depends upon thorough careful examination and diagnosis followed by an early exploration and repair using a microsurgical technique.
Following a sharp laceration to any peripheral nerve, there is complete transection of axons. Axons within the distal stump of the nerve undergo a process termed Wallerian degeneration. This involves axonal degradation and loss of neuromuscular conduction.
The current standard surgical treatment is an epineurial repair with microsurgical techniques, some of which are demonstrated in this section. The aim of nerve repair is to realign the proximal and distal stumps to allow axons to regenerate into the distal stump and provide reinnervation.
Often a primary repair cannot be performed without excessive tension, either due to necessary debridement of the nerve ends, a delayed repair in a fibrotic bed or local anatomical factors.
In these cases an interpositional nerve autograft can be used to bridge the gap. More recently other technologies such as nerve conduits, and processed nerve allograft may be used to bridge small gaps and detension the repair site. All of these techniques are described elsewhere on Orthoracle.
The following case illustrates the technique used in the direct repair of a partial median nerve division in the forearm.
Author:Tahseen Chaudhry, Consultant in hand and peripheral nerve surgery
Institution: University Hospital Birmingham, Birmingham, United Kingdom