The current state of peripheral nerve surgery in the upper limb.
The basic principles of nerve repair are still valid. Modern technique has resulted in greater interest and confidence in nerve grafting than before. Vast mobilization to achieve neurorrhaphy by force is obsolete. If there is a defect and coaptation difficult, the nerve graft is the answer. If the surgeon, performing primary surgery, has decided to accept tension, he should use a technique which enables him to do so, this is trunk-to-trunk coaptation with epineural stitches. On the other hand microsurgery permits isolation of fascicles and fascicle groups and dissection within the nerve. This makes a more accurate coaptation possible. If the surgeon decides to perform such an operation, surgical manipulation has to be minimized and, therefore, tension should be completely avoided. Microsurgery provides the tools to operate within the nerve without punishment by strong tissue reaction. A differentiated approach to the problem of lesion in continuity is possible, allowing evaluation of large fascicles or fascicle groups in dependently instead of a rather global evaluation of the whole trunk.
D000293:Adolescent; D000328:Adult; D001132:Arm / Q000294:innervation* / Q000601:surgery; D001134:Arm Injuries / Q000601:surgery*; D001917:Brachial Plexus / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000517:prevention & control / Q000601:surgery; D009463:Neuroma / Q000601:surgery; D059348:Peripheral Nerve Injuries; D010525:Peripheral Nerves / Q000601:surgery* / Q000637:transplantation; D010524:Peripheral Nervous System Neoplasms / Q000601:surgery