Correlating Time from Injury and Rate of Nerve Grafting: A Retrospective Review
Nirbhay S. Jain, MD1; Meaghan L Barr, MD2; Jones Ford Neil, MD3
1University of California, Los Angeles, Los Angeles, CA; 2University of California Los Angeles, Los Angeles, CA; 3UCLA, Los Angeles, CA
Introduction: Upper extremity peripheral nerve injury outcomes improve when primary neurorrhaphy is achieved expeditiously. A retrospective analysis was performed to determine at which point in time primary repair of a sharp nerve laceration cannot be performed and nerve grafting becomes necessary in order to better define the timeframe when primary nerve repair still remains possible.
Methods: A retrospective analysis of all patients with a sharp laceration of an upper extremity peripheral nerve over the past five years was performed, excluding other mechanisms of injury. Injuries were separated into three regions: major radial/median/ulnar nerves, common digital nerves, and proper digital nerves. Time from injury to repair, need for nerve grafting, length of graft, and degree of recovery at latest follow-up were collected and analyzed. Additionally, the impact of vascular injury on outcomes was studied in both grafted and not grafted populations.
Results: Two hundred ninety-six sharply lacerated nerves were included. Proper digital nerves could be repaired primarily in a majority of cases even several months after injury. For common digital nerves, primary repair could be performed several weeks after injury. For major nerves, nerve grafting became necessary only four days after lacerations.
Overall, return of function was evident in all levels of injury. Consistently, patients requiring nerve grafting had a poorer return of function when compared to those who had primary repair. For patients with concomitant vascular injury, rates of recovery in grafted major nerves were much lower than those without vascular injury. Patients with primary repair were not affected by the presence of vascular injury.
Patients were also stratified by age. Patients younger than 20 years and older than 40 years had lower rates of grafting when compared to those between 21 and 40. Rates of recovery were higher after primary repair when compared to nerve grafting across all age groups.
Conclusions: Patients with proximal nerve injuries predominantly required nerve grafting if surgery is delayed more than four days after injury. Primary repair of common and proper digital nerves could be achieved up to two weeks or greater after injury. Patients 21-40 had higher rates of grafting than younger or older patients. Grafted patients had worse outcomes than primarily repaired patients, exacerbated by vascular injury and independent of level or age. This study demonstrates that expeditious surgical intervention of sharp nerve injuries, especially major nerves, is critical in ensuring primary repair and optimizing patient outcomes.
Back to 2023 Abstracts