Peripheral nerve injuries. Nerve sutures and nerve grafting.

In the repair of transected peripheral nerves it is attempted to achieve an optimal coaptation of the fascicular tissue. A certain amount of fibroblast activity is essential for nerve regeneration but the fibroblast activity should not be overwhelming. At present fibroblast activity can be reduced only -by resection of the epineural tissue in nerve segments, in which it represents a high percentage of the cross-section (polyfascicular nerve structure with group arrangement), -by reducing the surgical trauma to a minimum, -by reducing the application of foreign material to a minimum, -by avoiding tension at the suture site, -by performing a proper resection, and -by adjusting the type of coaptation to the structure prevailing in the two nerve stumps. In clean cuts without major complications primary nerve repair is recommended. The patients have to be followed and, if within six months no signs of recovery occur, re-exploration is indicated. Complicated cases with nerve defects should be treated by early secondary repair. If during secondary repair an end-to-end coaptation can not be achieved easily, the application of nerve grafts is the treatment of choice.