Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan;20(1):92-97.
doi: 10.1177/15589447231198125. Epub 2023 Sep 14.

The Effect of Surgical Timing on Upper Extremity Nerve Repair

Ali Azad  1 , Amy Birnbaum  1 , Rachel Roller  1 , Matthew T Kingery  1 , Jeffrey Chen  1 , Jacques H Hacquebord  1
Affiliations

The Effect of Surgical Timing on Upper Extremity Nerve Repair

Ali Azad et al. Hand (N Y). 2025 Jan.

Abstract

Background: The purpose of this study was to evaluate the association between timing of nerve repair and the ability to perform a primary nerve repair versus a bridge repair requiring the use of allograft, autograft, or a conduit in lacerated upper extremity peripheral nerve injuries.

Methods: This is a retrospective case-control study of patients who underwent upper extremity nerve repair for lacerated peripheral nerves identified by Current Procedural Terminology codes. Timing of injury and surgery, as well as other information such as demographic information, mechanism of injury, site of injury, and type of nerve repair, was recorded. The odds of a patient requiring bridge repair based on the duration of time between injury and surgery was evaluated using logistic regression.

Results: A total of 403 nerves in 335 patients (mean age 35.87 ± 15.33 years) were included. In all, 241 nerves were primarily repaired and 162 required bridge repair. Patients requiring bridge repair had a greater duration between injury and surgery compared with patients who underwent primary repair. Furthermore, the nerves requiring bridge repair were associated with a greater gap compared with the nerves repaired primarily. Based on logistic regression, each 1-day increase in duration between injury and surgery was associated with a 3% increase in the odds of requiring bridge repair.

Conclusions: There is no defined critical window to achieve a primary nerve repair following injury. This study demonstrated that nerve injuries requiring bridge repair were associated with a significantly greater delay to surgery.

Keywords: allograft; bridge repair; injury; nerve; primary repair.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Distribution of the duration between injury and surgery for nerves that were amenable to primary repair and nerves that required bridge repair.
Figure 2.
Figure 2.
Probability of requiring bridge repair following upper extremity nerve laceration based on the duration between injury and surgery.
See this image and copyright information in PMC

References

    1. Taylor CA, Braza D, Rice JB, et al.. The incidence of peripheral nerve injury in extremity trauma. Am J Phys Med Rehabil. 2008;87(5):381-385. doi:10.1097/PHM.0B013E31815E6370. - DOI - PubMed
    1. McAllister RM, Gilbert SE, Calder JS, et al.. The epidemiology and management of upper limb peripheral nerve injuries in modern practice. J Hand Surg Br. 1996;21(1):4-13. doi:10.1016/S0266-7681(96)80004-0. - DOI - PubMed
    1. Moore AM, Wagner IJ, Fox IK. Principles of nerve repair in complex wounds of the upper extremity. Semin Plast Surg. 2015;29(1):40-47. doi:10.1055/S-0035-1544169. - DOI - PMC - PubMed
    1. Birch R, Raji AR. Repair of median and ulnar nerves. Primary suture is best. J Bone Joint Surg Br. 1991;73(1):154-157. doi:10.1302/0301-620X.73B1.1991753. - DOI - PubMed
    1. Leclercq DC, Carlier AJ, Khuc T, et al.. Improvement in the results in sixty-four ulnar nerve sections associated with arterial repair. J Hand Surg Am. 1985;10(6Pt2):997-999. doi:10.1016/S0363-5023(85)80023-X. - DOI - PubMed

LinkOut - more resources