Nerve injury associated with acute vascular trauma.

Nerve injuries associated with acute vascular trauma are a formidable obstacle to restoring useful limb function. Nerve injury has become the primary cause of long-term disability as the success rate of acute revascularization has risen to well over 90 per cent. Nerve injuries occur in roughly 60 to 70 per cent of upper-extremity vascular injuries and in approximately 25 per cent of lower-extremity vascular injuries. These neural injuries account for a permanent disability rate of between 27 and 44 per cent. Establishing early continuity of completely transected nerves along with early exploration of lesions in continuity provides the best chance for timely axonal regrowth and reinnervation of the distal musculature. The use of intraoperative nerve action potential monitoring has allowed us to explore lesions in continuity earlier without unnecessary resection and suture of lesions showing sufficient axonal regeneration. At present, because of the relatively slow rate of axonal regeneration seen in axonotmetic or neurotmetic injuries (after repair), very proximal nerve injuries in either the upper or lower extremity will continue to lead to disappointingly poor motor recovery in the limb distally.