Chapter

The Nerve Gap

Thomas M. Brushart

in Nerve Repair

Published on behalf of Oxford University Press

Published in print May 2011 | ISBN: 9780195169904
Published online September 2012 | e-ISBN: 9780199965168 | DOI: http://dx.doi.org/10.1093/med/9780195169904.003.0008
The Nerve Gap

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  • Sensory and Motor Systems
  • Rehabilitation Medicine

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Peripheral nerve gaps may be bridged with a variety of structures, or circumvented with location-specific strategies. Surgically revascularized nerve grafts are most helpful in scarred beds. The use of cellular nerve allograft is limited by the risks of immunosuppression. Grafts of acellular nerve and muscle basal lamina convey axons across short gaps. The performance of permeable tubular prostheses in bridging digital nerve gaps is equal to that of autologous nerve. Direct muscle neurotization can be effective when axons are distributed widely. Similarly, end-to-side nerve repair, which functions largely through terminal reinnervation from injured donor axons, is most effective at the level of distal sensory and motor nerves, but is ineffective at the nerve trunk level. Distal nerve transfer is a popular alternative to proximal nerve reconstruction, as it provides a functionally discrete, freshly axotomized axon population that can be directed to target muscle or skin over short distances, promoting rapid reinnervation and minimizing end organ atrophy.

Chapter.  34234 words.  Illustrated.

Subjects: Sensory and Motor Systems ; Rehabilitation Medicine

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