Timing for exploration of nerve lesions and evaluation of the neuroma-in-continuity.

Despite complete distal neurologic deficit, not all sharp injuries to an extremity transect or even partially divide nerve. These injuries may require delayed intraoperative electrophysiologic evaluation to determine whether neurolysis or resection and repair is necessary. On the other hand, where nerve is sharply and completely divided, there are many advantages to acute or primary repair, especially with brachial, plexus, and sciatic nerve transections. Where nerves are bluntly divided, stumps should be tacked down to adjacent fascial or muscular planes and repair delayed for two to three weeks carved out so that the stumps can be sectioned back to healthy neural tissue. A partially lacerated nerve, if explored in a delayed fashion, may require suture or more likely a nerve graft repair of some fasicular groups, and neurolysis of others or what can be referred to as a split procedure. Urgent or very acute indications for operative intervention are few but are important ot keep in mind. Blunt injuries are responsible for the majority of lesions-in-continuity. These injuries can be followed clinically and electrically for two to three months. If there is no clinical or electrical reversal of the proximal portion of the distal loss, then exploration is in order. A decision whether or not to resect a lesion-in-continuity, based on gross or even operating microscopic appearance, has been difficult to make. For this reason, stimulation and stimulation and recording techniques were used to measure early regeneration in 600 cases with acceptable results.