September 6, 2023
Nerve injuries still occur.
It is a real, everyday thing when a person inadvertently cuts themselves with a very sharp knife or utility knife or perhaps on a piece of cut glass working sheet metal. It can be a self-defense wound against a knife-wielding assailant. Ideally, when a nerve is transected completely, the ends should be repaired within about a week because after that, there is often times enough healing to make repair more difficult and sometimes the retraction of the cut ends makes the repair more difficult necessitating interposition nerve grafting or insertion of neurotubes. Upon nerve transection, the end closest to a person’s head tends to swell substantially making delayed repair a little more difficult and perhaps less accurate as well. There is no good data to show the difference in results, however, in early versus later repair of nerves.
Advances in Nerve Repair
The newest thing in nerve repair that has evolved over the past 20 years or so is the use of allograft nerve, that is nerve harvested from people who have listed their body parts for donation in the event of an untimely death when otherwise healthy. Antigens, those proteins responsible for immune response, are eliminated with microtubules through which the nerve fibers creep to their ultimate destination and help guide the nerve. Results using allograft are close to those doing direct nerve repair or grafts taken from somewhere else on the injured person’s body.
The picture below is of a digital nerve in a ring finger that was cut almost three weeks prior with a utility knife. The patient had severe pain and a live nerve ending. The nerve ends were well-separated so that it never would have healed without surgical exploration. In this case, an anatomic, direct, end-to-end repair was undertaken without tension and essential for a good nerve repair result using interrupted 9-0 sutures. The suture is thinner than a baby’s hair. He will be placed in a splint for four weeks, then allowed to move it, and will await the result of the nerve healing over the course of a minimum of three months. In this case, an Avance nerve protector was wrapped around the repair site to help prevent hypersensitivity at the repair site.