Achieving Success in Complex Nerve Repair of the Hand: A Lengthy Team Effort

Repair of damaged peripheral nerves, introduced some twenty-four centuries ago, continues to present opportunities and vexing challenges to surgeons and patients. Unlike neural tissue in the central nervous system, peripheral nerve fibers can regenerate, but achieving success is often a long road of healing, surgery, and occupational therapy. According to Kenneth Taylor, M.D., Penn State Hershey Bone and Joint Institute, “Nerve injury in the arms and hands may be associated with complex lacerations, machinery accidents, or automobile crashes. Life-threatening injuries need to be addressed first, and nerve repair is secondary, done sometimes weeks or months later.” More often, nerve repair can be done in the acute post-injury period.

“When there is a clean injury of a digital nerve, the transected fibers can be sutured together during primary treatment of the wound. Most patients will have a complete recovery,” notes Taylor. Many nerve injuries, however, are much more complex, with extensive damage to surrounding bone and soft tissue. Having formerly served in the military, Taylor gained experience carrying out some of the most complex nerve reconstruction procedures in veterans wounded in Iraq and Afghanistan.

Demonstrating segmental loss of median nerve in the forearm

Demonstrating segmental loss of median nerve in the forearm

To plan complex nerve repair, Taylor explains, “It’s often essential to obtain advanced imaging, electrodiagnostic tests and to coordinate with orthopaedic traumatologists, occupational therapists, and other specialists to address two key elements in any nerve repair procedure – viable nerve tissue and viable target tissue. What nerve fibers are damaged? What nerves may recover without surgical repair? What nerves are intact and potentially useful for future surgical options? Are target tissues healthy and functional?” Taylor says, “Healthy target tissue is critical for proper re-innervation. Some patients may require tendon or functional muscle transfer for a reconstruction to be a success.”

By contrast, other patients may have healthy target tissue, but irreparably damaged nerve fibers, requiring more complex nerve transfers or grafts. “For successful nerve transfer, the donor nerve must exhibit functional redundancy or overlap with the damaged nerve, as is the case with a high ulnar nerve injury. Branches of the intact median nerve can be re-routed to restore hand function.” Patient post-operative care is a critical component of repair success. “Patients need to know that nerve regrowth is slow. Repair success may not be evident for months. During recovery, surgeons and patients need to maintain a strong commitment to rehabilitation and other types of follow-up care.”

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Photo of Kenneth F. Taylor, M.D.

Kenneth F. Taylor, M.D.

Kenneth F. Taylor, M.D.

  • Chief, hand and wrist orthopaedic surgery
  • Associate professor, orthopaedics and rehabilitation
  • Phone: 717-531-2948
  • Fellowship: Hand surgery, Walter Reed Army Medical Center, Washington, DC
  • Residency: Orthopaedic surgery, Walter Reed Army Medical Center, Washington, DC
  • Internship: Transitional, Walter Reed Army Medical Center, Washington, DC
  • Medical School: Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, MD

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Filed under Healthcare Practice, Musculoskeletal Sciences

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