Peripheral nerve

Abstract

In order to understand peripheral nerve dysfunction, and to follow neuronal regeneration, basic sciences of the peripheral nerve should be understood completely. A surgeon who operates on “nerves” uses this knowledge, especially the organization of the peripheral nerve, in nerve reconstructions. When a nerve has been injured, the goal of surgical repair is generally to reapproximate the ends of the injured nerve. However, this cannot be possible in some occasions. If a primary suture is not feasible due to local tissue trauma, appropriate grafting of short and long defects is still the golden standard procedure. To bridge the nerve defects, the interfascicular autologous nerve grafting technique is still considered the “gold standard” but many other different “grafts” have been studied. In the presence of a critical motor target distance, one should consider distal motor nerve transfers. An alternative in late cases (after 6–12 months) is only provided by free muscle transfers, replacing the chronically denervated muscle with a newly denervating muscle, which the growing motor nerve should reach in the shortest time. Although nerve transfer surgery cannot fully replace functional restorations with tendon transfers, it has become a viable option in many cases. Overall, combination of nerve transfers with tendon transfers may provide better outcome.