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EMERGENCY

Nerve Suture

Microsurgical repair of sectioned nerves

Microsurgical emergency

Nerve section requires rapid and precise surgical repair to allow nerve regeneration and sensory and/or motor recovery.

What is the role of hand nerves?

Hand nerves ensure two essential functions: sensitivity (perception of touch, temperature, pain) and motor function (control of intrinsic hand muscles). Nerve section leads to loss of function in the affected nerve territory.

How does nerve section present?

After a deep wound to the hand or finger, the patient may notice:

  • Loss of sensitivity (numbness, insensitivity to touch) in one or more fingers.
  • Loss of strength or inability to perform certain fine movements of the thumb or fingers.

Any deep wound with loss of sensitivity must be considered an emergency and suggests nerve section.

Are all nerve traumas identical?

No. We distinguish three types of nerve injuries, of increasing severity:

Neurapraxia

Functional "stunning" of the nerve, which keeps its anatomical structure intact. Recovery is spontaneous in a few hours, days or weeks, without surgery.

Axonotmesis

The axon (conducting cable) loses its continuity but the nerve envelope persists. Recovery is possible through guided regeneration, in several months.

Neurotmesis

Complete nerve section with loss of continuity of all elements. Without surgical repair, no recovery is possible.

Note: Palsies associated with fractures recover spontaneously in more than 80% of cases in 2 months (simple neurapraxia).

How is surgical repair performed?

Repair of a sectioned nerve requires high-precision microsurgical technique. The intervention is performed under operating microscope, with extremely fine threads and needles.

The objective is to restore nerve continuity by matching fascicles (nerve fiber bundles) as precisely as possible, to guide axon regrowth to their original targets.

What happens after repair?

Nerve regeneration is a slow and progressive process:

  • • The nerve regrows at a rate of about 1 mm per day (about 2.5 cm per month).
  • • Sensitivity recovery therefore takes several months, depending on the distance between the repair site and the fingertip.
  • • Recovery quality depends on age (better in young patients), injury type and repair precision.

Sensory reeducation may be offered to retrain the brain to interpret signals from the regenerating nerve.

Is nerve repair risk-free surgery?

No, of course not. Sequelae are frequent, even after technically satisfactory repair:

Incomplete sensitivity recovery

Recovered sensitivity is often different from original sensitivity (dysesthesias).

Neuropathic pain

Pain and cold intolerance persist in most cases, even after good recovery.

Incomplete motor recovery

Recovery of intrinsic muscle strength is often partial.

Painful neuroma

In absence of repair or in case of chaotic nerve healing.

Wound with loss of sensitivity?

Any deep wound with loss of sensitivity must be considered an emergency.

Emergency: 112 | Institute: +352 2468 4141

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