Dr.Kamil Pietrasik
language: Polish
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Nerve injuries in upper extremity are most frequently caused by accidental lacerations with sharp objects.

Resulting partial or complete nerve damage causes sensory and/or motor dysfunction. Less frequently, it may result from nerve compression (neuropraxia) by tumor, bone or soft tissues.

Neurons in peripheral part of completely lacerated nerve undergo degeneration and never regain their function. Those in proximal part survive and play crucial role in nerve regeneration. The process may take place only if there is not any gap or scar tissue present between proximal and distal stumps impeding passing of neurons. The best results are obtained if nerve is repaired primarily i.e. just after the injury. If such a repair is not possible or unindicated it is performed as secondary procedure i.e. several weeks after the injury. Surgical treatment aims at restoration of continuity of lacerated nerve bundles by suturing of separated parts or if it is not possible by nerve grafting.

Surgery is performed in regional blockade of brachial plexus or general anesthesia. Accurate adaptation and suturing of nerve bundles performed under the microscope is most important but not the only factor determining success of treatment. During the operation anatomical conditions are created for nerve regeneration. It doesn’t mean immediate restoration of its function.

Regeneration process is faster in non-smokers and younger (< 40 y.o.) individuals in a rate of 1mm/day. Another  important factor determining duration of regeneration is level of injury. The entire process may take from 6-14 months.

Despite most accurate and precise fascicles adaptation, restored function will never be as good as before the injury. Moreover, it may also turn out impossible to restore function of the nerve. Generally it is known that nerve regeneration is better if nerve injury is more peripheral, in younger and non-smoking individuals.

Operated part is immobilized in cast for 3 weeks. Skin sutures are removed 14 days after the surgery.

In preoperative and postoperative period adequate hand therapy is very important for obtaining good result.

This short information doesn’t replace medical consultation in the office.

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