Decision Making After Nerve Injury of Upper Extremities

Background: Trauma of peripheral nerves are common and it is one consequence of a traumatic extremity injury. Recovery of muscle and tendon activity and restoration of sensibility are essential for a functional extremity. Management of injuries of peripheral nerves are challenge for decision-maker. It is important to make the right decision in the management of peripheral nerve injury. Objective: The aim of this study was to show the importance of algorithm that we use in the treatment of peripheral nerve injury of upper extremities and to explore the factors that influence the decision-making process. Patients and methods: In retrospective study, we analyzed 48 patients who were treated at the Clinic for Plastic and Reconstructive surgery in the period from January 1st 2000 to January 1st 2005, aged from 8 to 57 years (mean 31 years). In the study were included patients with nerve injury of upper extremity. Results: The percentage of patients with neurapraxia who successfully recovered without surgery was 88%. In complete nerve lesion with extensive damaged surrounding tissue or burned tissue, we had adequate results in 71%, while in isolated sharp injury we had adequate results in 20 patients (80%). In all patients with inadequate results, we preformed satisfying re-operation, which mean neurolysis, placement of a nerve graft or tendon transfer. Conclusion: The algorithm that we use and which we have accepted, made possible to get good results that we were satisfied. A sharp laceration, such as a knife wound, has a good prognosis. If a crush component is present, the wound should be free of debris and contamination that may compromise healing. Neurapraxia has a relatively short recovery time, and full function is expected without intervention by 12 weeks after presentation.