Traumatic Neuropathies

Question 1

For clean sharp nerve injuries, what is the treatment algorithm?

Answer 1

directly repaired (end–end) within days

Question 2

For contaminated/blunt nerve injuries, what is the treatment algorithm?

Answer 2

acutely debrided, tag nerve ends/suture to surrounding tissue to preserve length, repair ~ 3 weeks later when healthy nerve ends declared/demarcated (often need graft)

Question 3

For closed nerve injuries, what is the treatment algorithm?

Answer 3

early intervention only for vascular compression; otherwise establish baseline exam, follow for 3 months to rule out neurapraxic injury; electromyography and nerve conduction studies useful > 3 weeks postinjury; repair in ~ 3 months if no recovery