Nerve Repair: Basic Science and Current Concepts

Abstract

Peripheral nerve injuries are common in the orthopaedic practice. Most of these injuries are incomplete. Seddon classified nerve injuries into three types: neurapraxia, axonotmesis, and neurotmesis. When axons are transected or crushed, neurons undergo degeneration, followed by regeneration of axons from the proximal stump. Growth cones, located at the tips of the daughter axons, seek out connections with the degenerated distal stumps through contact-mediated and chemotactic factors. Epineurial repair using nylon sutures is the current standard of surgical repair. Group fascicular repair can also be performed, although this technique is more technically challenging. Currently, there are no significant data suggesting that one method is better than the other. To span larger nerve defects without placing undue tension on the repair, nerve grafts may be used. Today, there is much ongoing research regarding the use of artificial nerve-guidance channels, pharmacologic agents, immune system modulators, and enhancing factors, which may offer promise for future improvements in nerve repair outcomes.

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