gms | German Medical Science

Objective: Peripheral nerve injuries are still underestimated. The surgical treatment of traumatic nerve lesions of the upper extremities will be presented. The different surgical techniques have been analyzed with regard to the long-term outcome.

Methods: The retrospective study presents the data of 93 patients (female: 24; male: 69) who were operated on for peripheral nerve injuries of the upper extremities at our department between 1991 and 2003. Average age was 31 years, ranging from 5 to 67 years. Altogether 100 traumatic nerve lesions (ulnar nerve: 20; radial nerve: 25; median nerve: 25; axillary nerve: 6; accessory nerve: 7; musculocutaneous nerve: 2; long thoracic nerve: 1; digital nerve: 3; combined nerves: 7) were surgically treated. Surgical management included primary nerve suture in 16, neurolysis in 25, and nerve transplantation in 59 patients.

Results: 74 patients (80%) were available for follow-up examination. The mean follow-up period was 35 months (6-132 months). All patients up to 20 years of age demonstrated good or excellent results in accordance with the motor function. However, in 79% of the patients older than 20 years of age a good functional outcome was observed. Overall, good to excellent improvement of motor function was achieved for lesions of the musculocutaneous, radial, accessory and axillary nerve (100%, 89%, 100%, 100% functional useful muscle innervation, muscle recovery grade 3 and more). The length of grafts, in cases of secondary nerve reconstruction, did not influence functional outcome.

Conclusions: Generally, early surgical repair of a nerve lesion predicted a better outcome. A good functional motor recovery was dependent on the age of the patient. Traumatic nerve lesions, without signs of reinnervation, should be treated surgically within a period of three months after injury.