Nerve repair and reconstruction

With so many bones, ligaments, tendons, and joints keeping hands and wrists working, there is ample opportunity for injury. In fact, the hand is one of the most commonly injured parts of the body. With a wealth of international experience in hand trauma surgery Dr Mackenzie can offer the latest techniques in nerve repair and reconstruction, tendon repair and reconstruction and neuroma management.

Despite the many advances made in microsurgical techniques and instrumentation, the functional outcome of a repaired nerve will never be exactly the same as before the injury.

Nerve repair SURGERY – FACTS

Length of surgery	1-3 hours, depending on the extent of injury
Anaesthesia	General or regional anaesthetic
Hospital stay	Day case
Risks/complications of surgery	Frequent: Swelling, stiffness, discomfort on movement Infrequent: Infection, bleeding (haematoma), delayed wound healing, painful scar, damage to the nerve, neuroma, adhesions, complex regional pain syndrome, no improvement
Recovery	2 to 4 weeks resume light activities, such as using a keyboard or writing with a pen 5 to 6 weeks resume medium activities, such as light lifting or shelf stacking 6 to 8 weeks resume heavy activities, such as heavy lifting or building work 6 to 8 weeks resume sporting activities 3-9 months until final result
Driving	8-10 weeks
Hand position	Elevation above the heart level
Follow up	1 week, 6 weeks, 3 months, 6 months
Duration of results	Results can be unpredictable with nerve surgery

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Nerve Repair

Any hand surgery procedure is a personal choice and understandably there are a number of questions that arise. This information sheet is a general guide for patients considering nerve repair under the care of Dr Mackenzie. It should provide the answers to some questions that you may have.

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What is a nerve?

A nerve is like a wire that carries messages back and forth to the brain. The messages to the brain are information about feeling (sensory impulse) and from the brain to tell the muscles to contract (motor impulse). Many small fibers are bundled inside each nerve to carry the messages. There is an outer layer that insulates and protects the nerves.

What happens when a nerve is injured?

There are three basic types of injury to a nerve.

Nerve is bruised and stops working properly for a short period of time. All the inner cables (nerve fibres) remain intact. With this type of injury the nerve normally recovers fully and leaves no deficit. This is called a neurapraxia. If the nerve is bruised or traumatized but is not cut, it should recover over 6-12 weeks.
The inner cables (nerve fibres) of the nerve are damaged but the outer layer remains intact. For the nerve to recover the inner cables (nerve fibres) have to grow back down the tubes. Recovery from this type of injury is unpredictable.
The nerve is completely divided. Here both the outer layer and inner cables (nerve fibres) are divided. This type of injury requires the nerve to be repaired if it is to recover.

How long does it take for the nerve to regenerate?

Factors that may affect results after nerve repair include:

Age (he younger you are, the quicker and the better the recovery time)
Type of wound
Type of nerve (sensory vs motor)
Level and cause of the injury (the higher up your arm the injury occurs, the slower the recovery time for your hand)
Delay between injury and repair

The important thing to remember is that nerves take many months to repair themselves. The nerve grows back at about 1mm per day and the final result may not be known for two years or more.

Sensory nerves can recover sensation months or years after injury; however, motor nerves have a time limit for healing otherwise the muscle will waste away.

Muscle power or skin sensation may never return to pre-injury levels.