Nerve Repair

Peripheral nerves are biologic wires that convey the desire for motion from brain to muscle, and the experience of touch from skin to brain. When a nerve is cut, the individual fibers, or axons, must regenerate from the site of injury to reconnect with their skin and muscle targets. Nerve regeneration is a process of bewildering complexity that requires the coordinated action of multiple biologic systems. Gene expression within the neuron is altered to support axon growth, regenerating axons must cross the complex environment of the nerve injury and enter pathways that lead to functionally appropriate end organs, Wallerian degeneration clears these pathways of axon debris, and Schwann cells in the distal nerve must produce growth factors to support regeneration. In spite of this complexity, the surgical repair of transected nerve remains a mechanical process that has changed little in the last century, and that restores normal function to only 10% of adults with nerve injuries. Improving the outcome of nerve repair will require close cooperation between surgeon and scientist. Skyrocketing clinical demands on the surgeon and the rapidly increasing sophistication of neuroscience have interacted to form two distinct cultures. Nerve Repair bridges these cultures by providing a translational review of the clinical and basic science relevant to nerve repair. It provides the clinician with an understanding of pertinent research, and the basic scientist with an overview of the clinical manifestations of nerve injury and regeneration. It is also grounded in the history of peripheral nerve surgery and biology so that modern concepts can be understood in the context of their origins.