Page 72 - Read Online

Page 10 of 13 Titolo et al. Plast Aesthet Res 2023;10:21 https://dx.doi.org/10.20517/2347-9264.2022.113

formation; in injuries older than 6 months, reconstruction techniques can still be undertaken.

For mixed/motor nerve injuries, instead, the authors recommend immediate repair (within 24 hours of
injury) when possible, because motor end-plate degradation limits the amount of time available for any
functional motor return. For the same reason, in case of delayed presentation (more than 6 months after
complete transection), efforts should be taken to provide axons to the muscle end-plates no later than 1 year
and a multifactorial approach, including nerve grafting, nerve transfer, and/or tendon transfer is suggested
to restore function .
[70]

Beyond this time period, it seems unrealistic to expect nerve surgery to work; when the degeneration of the
motor end-plates, muscle atrophy, and replacement of muscle fibers by fatty tissue occurs, tendon transfer
[53]
surgery becomes the only possible surgical treatment . Due to different structure characteristics, it has
been shown that functional sensory recovery may be achievable several years after complete transection, but
the results are less predictable [64,71] .

CONCLUSION
Functional recovery in hand nerve defect treatment is gradually improving in recent years. A deeper
knowledge of innervation anatomical patterns combined with a classification language widely shared by
specialists has provided great advantages in recognizing and guiding surgical treatment of patients whose
quality of life would otherwise be compromised. Regarding surgical options, microsurgical direct nerve
repair is still the gold standard for peripheral nerve repair whenever a tension-free and early repair are
possible. It should be remembered, however, that nerve repair requires healthy supportive tissue to achieve
optimal results. If there is a large nerve defect, an autologous nerve graft is accepted as the gold standard
procedure.

Treatment of small nerve gaps is still an area of intense scientific research, but at the present time, no
method has been proven superior to others; several elements, such as each technique’s feature, surgical
experience, and clinical setting, must be evaluated. Numerous alternatives in nerve injury management have
been provided by the advantages granted by nerve transfer procedures, and in some cases, a combination of
nerve repair and immediate tendon transfer may lead to an early function recovery. Finally, when nerve
surgery cannot be considered a solution, secondary surgery, such as tendon transfer procedures, still plays a
significant role in improving the patient's hand function.

DECLARATIONS
Authors’ contributions
Concept and design: Titolo P, Fanecco A
Data acquisition, data analysis, manuscript preparation: Fanecco A
Critical revision and completion of manuscript: Titolo P

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.