Nerve Repair

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Evolution of Nerve Repair

The method of nerve repair also depends on the type of injury and the amount of nerve that is injured. The simplest method of repair is called direct repair and it works best when the injury is a clean cut through the nerve.

Direct repair re-connects the two nerve ends and uses small suture to re-attach the cut ends of nerve tissue. Direct repair has been in use since the late nineteenth century. In the 1960’s direct repair began to be performed under a microscope. This is the method currently in use for clean cuts through a nerve, where the nerve can be repaired without tension.

Nerve repair becomes much more challenging when a gap exists between the two nerve ends or where there is tension on the nerve repair when the cut ends are approximated. The gap may be caused by the actual injury or may result when the surgeon has to remove injured nerve tissue that did not recover well. In this case, the ends of the nerve cannot be simply re-connected because of the gap between the ends.

If the gap is very small, a nerve conduit (basically a tube) may be placed to connect the ends and guide the growth of the recovering nerve. For a longer gap, a piece of nerve (either from the patient or a donor), called a graft, will need to be inserted to span the gap. A patient’s own sensory nerve, called an autograft (a graft from the patient him/herself), may be used as a graft to re-connect an injured nerve.

The downside to this is that, since a sensation-carrying nerve was cut out and used as a graft, the patient will be left with an area that no longer has sensation. The patient also has a limited amount of nerves that can be used as grafts and the procedure to harvest the graft involves a second surgery site. Alternatively, a nerve allograft (a graft not from the patient) may be used from a donor.

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