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. 2021 Sep 1;87(3):e1-e21.
doi: 10.1097/SAP.0000000000002767.

Evidence-Based Approach to Timing of Nerve Surgery: A Review

Brendan J MacKay, Cameron T Cox  1 , Ian L Valerio  2 , Jeffrey A Greenberg  3 , Gregory M Buncke  4 , Peter J Evans  5 , Deana M Mercer  6 , Desirae M McKee, Ivica Ducic  7
Affiliations

Evidence-Based Approach to Timing of Nerve Surgery: A Review

Brendan J MacKay et al. Ann Plast Surg. .

Abstract

Events causing acute stress to the health care system, such as the COVID-19 pandemic, place clinical decisions under increased scrutiny. The priority and timing of surgical procedures are critically evaluated under these conditions, yet the optimal timing of procedures is a key consideration in any clinical setting. There is currently no single article consolidating a large body of current evidence on timing of nerve surgery. MEDLINE and EMBASE databases were systematically reviewed for clinical data on nerve repair and reconstruction to define the current understanding of timing and other factors affecting outcomes. Special attention was given to sensory, mixed/motor, nerve compression syndromes, and nerve pain. The data presented in this review may assist surgeons in making sound, evidence-based clinical decisions regarding timing of nerve surgery.

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Conflict of interest statement

Conflicts of interest and sources of funding: Although this review was not directly funded by any grant, Texas Tech University Department of Orthopaedics does receive funding and grant awards to participate in the nationwide RANGER nerve allograft trial as well as investigating uses of AVIVE (human umbilical membrane) sponsored by Axogen. The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Treatment algorithm for elective cases currently in use by some centers. Piedmont Healthcare System, Georgia.
FIGURE 2
FIGURE 2
Peripheral nerve injury cascade of events leading to the unidirectional regeneration from proximal to distal stump. ATF2, activating transcription factor 2; ATF3, activating transcription factor 3; ERK, extracellular signal-regulated kinase; CaMKII, Ca2+/calmodulin-dependent protein kinase II; CNTF, ciliary neurotrophic factor; Fra-2, transcription factor; IL-6, interleukin 6; Islet-1, transcription factor; JNK, c-Jun N-terminal kinase; JunD, transcription factor; LIF, leukemia inhibitory factor; NCAM, neural cell adhesion molecule; NfKB, nuclear factor κB; NRG1, neuregulin 1; p-ERK1/2, phosphorylated extracellular signal-regulated kinase; P311, 8-kDa protein with several PEST-like motifs found in neurons and muscle; SC, Scwhann cell; Sox11, transcription factor; STAT3, signal transducer and activator of transcription 3.
FIGURE 3
FIGURE 3
Effect of Schwann cell insufficiency on distal nerve segments after prolonged discontinuity.
FIGURE 4
FIGURE 4
Management of peripheral nerve transection.
See this image and copyright information in PMC

References

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