Injuries to the peripheral nerves of the upper and lower limbs can be devastating. They can lead from temporary dysfunction to permanent paralysis of the affected extremity. Occasionally these type of injuries are associated with severe pain. Surgical repair of the injured nerve may not only reverse the paralysis but also may alleviate some of the pain.

Peripheral nerve injuries can be caused by numerous mechanisms such as

  • Stab wounds, gunshot wounds, or motor vehicle accidents.  These injuries are usually complex, involving sometimes the bones, the nerves, the muscles and vessels.
  • Work related injuries. (i.e. amputations or avulsions of the arm)
  • Nerve defects resulting from removal of nerve tumors.
  • Iatrogenic causes such as, inadvertent nerve injury during any type of surgery.

The surgical correction of these injuries usually involves     

  • exploration of the site,
  • identification of the proximal and distal nerve ends,
  • diagnosis of the lesion,
  • establishing a strategy for reconstruction, going over it in detail with the patient
  • and finally reconstruction.

The surgery may be staged. If there is simultaneous vessel injury then a vascular surgeon is consulted in order to restore adequate circulation to the affected limb, so its survival is not threatened. Correction of bone fractures is essential before any attempt to correct the nerve injury is made.

Therefore peripheral nerve injuries can range from simple injury limited to just the nerve, to complex injuries of the whole limb.

Video

BEFORE   AFTER
 
Injury of the common perineal nerve with paralysis of the foot (drop foot)
 

Complete restoration of foot dorsiflexion via common perineal nerve grafting

* Patient consent was obtained for publication of figures