The Assessment and Management of Peripheral Nerve Trauma

The purpose of this review is to discuss the therapeutic options available in the treatment of traumatic injuries involving peripheral nerves. For nerve gap repair, synthetic nerve tubes are limited to gaps below 3 cm in length and to small-diameter nerve repairs, whereas the dependency on proliferating host Schwann cell limits the size of acellularized autografts. Thus, in most situations, nerve autografts remain superior for nerve gap correction. When conservative treatment is either not indicated or ineffective, surgical intervention may be employed. The ideal timing of surgical intervention is often unclear and determined by a number of factors, including the circumstances surrounding the injury, the timing of the symptoms, the type and severity of the injury, the completeness of the lesion, the required regenerative distance, the degree of fascicular disruption, and the degree of concomitant tissue trauma and contamination, as well as the morbidity and mortality of the procedure, and the age and comorbidities of the patient. The most common nonsurgical error is unnecessary surgical delay. To avoid losing the opportunity to achieve successful motor recovery, it is important to involve a peripheral nerve surgeon early.