CURRENT ISSUES IN NERVE REPAIR

Although accepted surgical techniques for peripheral nerve repair rema in largely unchanged over the past three decades, much progress has be en made toward understanding the mechanisms involved in nerve regenera tion, and consequently toward providing adjunctive measures to enhance this regenerative process. We present a comprehensive review of the s ignificant advances made in several aspects of nerve repair over the p ast decade, and particularly the past few years, and provide a few exa mples of facial nerve repair using the standard neurorrhaphy technique s recommended today. Several conclusions were drawn after thorough rev iew of the literature. Early repair of injured nerves is preferred, an d there appears to be no benefit to waiting for 3 weeks. Severed nerve s should be repaired with monofilament 9-0 nylon suture placed in epin eurial fashion. Fibrin glue confers no benefit in reattaching injured nerves. Likewise, theoretical advantages of laser neurorrhaphy have no t resulted in improved nerve regeneration. Finally, trophic factors, s uch as apolipoproteins and nerve growth factor, and tubulization both appear to offer promise for future experimental and clinical progress in nerve repair. However, further work must be done to prove their eff icacy.