If a patient has a suspected nerve laceration, it is usually recommended that the nerve is explored in theatre. Once a nerve has been cut, the chance of recovery in the nerve function without a repair is very unlikely.
Nerve repair surgery is usually performed under general anaesthetic. For hand and forearm nerve injuries, surgery is carried out under a tourniquet control. This prevents blood flow in and out of the arm and provides a dry operating zone without any blood loss.
Often patients will have a clear laceration localising the injury. The traumatic laceration is usually extended and the wound is explored. Once the nerve has been identified, the extent of the injury is assessed.
The aim of a surgical repair is to restore the continuity of the nerve tube. Once a nerve tube has been cut, the nerve cell dies off. Surgery restores the continuity of the nerve tube through which the regenerating nerve cells will have a pathway to grow.
Often the nerves that are repaired are very small and the surgery may be carried out under a microscope.
Once the nerve has been repaired and the wound closed, the region is often immobilised in a splint to prevent undue movement at the nerve repair site.
After the first three weeks, the nerve repair is usually at good strength and the patient can start to move the effected hand as freely as able.
Unfortunately nerve recovery is very slow. Although the nerve tube is rejoined, the nerve cell will take many months to regrow and work itself along the pathway.
In cases of sensory loss, recovery can be expected over at least a two-year period. This can be quite frustrating for patients. In children, nerve regeneration tends to be more rapid and more complete.
In adults, it is difficult to predict the extent of nerve recovery. Some patients may be left with an incomplete return of nerve function. Other health factors can have a bearing on their recovery, such as diabetes and smoking.