Advances in peripheral nerve repair in emergency surgery of the hand.

The development of microsurgical techniques has changed the surgical treatment of severe hand injuries over the last 25 years. Not only has the repair of vessels by microvascular surgery brought new possibilities of treatment, but the results in repair or peripheral nerves have been improved by the use of new microsurgical techniques, such as perineural suture and interfascicular nerve grafts. The use of vascularized nerve grafts in multiple digit amputations has been a further new idea in emergency hand surgery. The operative treatment of lesions of the brachial plexus has become possible. Nevertheless, the traditional secondary operations such as tendon and muscle transfers are necessary in order to reach an optimal functional reconstruction following nerve injuries.