Nerve Injuries And Repair Of Nerves

Nerve injuries are very common in accidental cases and may cause significant morbidity in patients. There are two types of nerves in our body: a) sensory nerves and b) motor nerves. Sensory nerves are associated with the feeling of touch, pressure, hot, cold, taste, vision and smell whereas the motor nerves control the contraction of muscles and mobility of our body parts under the control of our will. Peripheral nerve injuries may lead to lack of muscular control and mobility of our arms, legs, hand or feet. Nerve fibre regeneration and reconstruction is there in clinical practice since the late 19^th Century. Nerve fibre regeneration after focal nerve injury varies with age, site and type of lesion. If the nerve ends could be approximated without any difficulty, end to end repair is possible. End to end repair is routinely practiced procedure for the repair of injured nerves. The situation becomes difficult in case of gap between the ends of the injured nerve. In such cases the options available are nerve graft or end to side repair using an adjoining nerve or nerve conduits.

In case of peripheral nerve injuries restoration of motor functions is considered useful for the patient. There may be needed to sacrifice a sensory nerve for restoring motor function by nerve grafting. Harvesting of sensory nerve for nerve graft to restore a motor function will create a non sensory zone in the patient. In cases of facial nerve reconstruction, the procedure of choice is end to side neurorrhaphy. Neurorrhaphy is a procedure wherein injured nerve is sutured to an intact nerve in its vicinity after transecting the distal segment provided the nerve is close to the neuromuscular junction. There is a great role of cellular and biochemical factors as myelin required for ensheathment of nerves undergoing repair and regeneration is produced by Schwann cells. End to side anastomosis with an adjoining healthy nerve is a new technique coupled with plastic surgery features and inputs. Only an experienced plastic surgeon with expertise in nerve repair surgical procedure or neurorrhaphy could be helpful.