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Review
. 2024 Apr 16;6(5):681-684.
doi: 10.1016/j.jhsg.2024.01.026. eCollection 2024 Sep.

Cutting-Edge Approaches for Nerve Debridement Prior to Repair

Lilah Fones  1 , Michael Rivlin  1 , Rick Tosti  1
Affiliations
Review

Cutting-Edge Approaches for Nerve Debridement Prior to Repair

Lilah Fones et al. J Hand Surg Glob Online. .

Abstract

Peripheral nerve injuries can be devastating. Although neuropraxic and some axonotmesis injuries will recover spontaneously, nerve repair or reconstruction is required to restore function in high-grade axonotmesis or neurotmesis injuries. The first step of nerve repair or reconstruction is adequate nerve debridement with removal of necrotic and fibrous tissues. Debridement decreases neuroma formation at the repair site and produces an optimal surface for axonal regeneration. This article discusses nerve debridement, including the goals of debridement, debridement techniques, and signs of adequate nerve debridement before repair.

Keywords: Nerve debridement; Nerve repair; Neuroma; Neuroma-in-continuity; Peripheral nerve.

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Conflict of interest statement

No benefits in any form have been received or will be received related directly to this article.

Figures

Figure 1
Figure 1
Injured radial sensory nerve entrapped with surrounding extraneural fibrosis requiring external neurolysis.
Figure 2
Figure 2
A Adequate nerve debridement is critical and should be performed even if it produces a larger nerve gap. B If a large nerve gap results from debridement, multiple repair techniques can be used, including conduits, allografts, or autograft nerves.
Figure 3
Figure 3
Intraoperative photograph demonstrating an example of improper debridement of the radial sensory nerve prior to repair demonstrating A neuroma-in-continuity adjacent to B previous suture line. Photo credit Kyle Eberlin, MD.
Figure 4
Figure 4
Intraoperative photographs on nerve repair. A Transected nerve following external neurolysis in a well vascularized wound bed. B Nerve positioned on tongue depressor and with tension applied for sharp transection with scalpel for excision of injured nerve end. C Sharp debridement of fibrotic intraneural fibrosis from healthy nerve. D Healthy nerve end following debridement allowing for visualization of individual nerve fascicles.
Figure 5
Figure 5
Example of specialized nerve cutting clamp, the Checkpoint Edge Nerve Cutting Kit (Checkpoint Surgical Inc).
See this image and copyright information in PMC

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