Millesi H
Ann Chir Main. 1984;3(1):18-34. doi: 10.1016/s0753-9053(84)80058-7.
The basic principles of nerve repair are still valid. Modern technique has resulted in greater interest and confidence in nerve grafting than before. Vast mobilization to achieve neurorrhaphy by force is obsolete. If there is a defect and coaptation difficult, the nerve graft is the answer. If the surgeon, performing primary surgery, has decided to accept tension, he should use a technique which enables him to do so, this is trunk-to-trunk coaptation with epineural stitches. On the other hand microsurgery permits isolation of fascicles and fascicle groups and dissection within the nerve. This makes a more accurate coaptation possible. If the surgeon decides to perform such an operation, surgical manipulation has to be minimized and, therefore, tension should be completely avoided. Microsurgery provides the tools to operate within the nerve without punishment by strong tissue reaction. A differentiated approach to the problem of lesion in continuity is possible, allowing evaluation of large fascicles or fascicle groups in dependently instead of a rather global evaluation of the whole trunk.
神经修复的基本原则仍然有效。现代技术使人们对神经移植的兴趣和信心比以往更高。通过强行广泛游离来实现神经缝合的方法已过时。如果存在缺损且难以进行对合，神经移植就是解决办法。如果进行一期手术的外科医生决定接受张力，他应采用一种能使其做到这一点的技术，即采用神经外膜缝合的干对干对合。另一方面，显微外科手术允许分离束状结构和束组，并在神经内部进行解剖。这使得更精确的对合成为可能。如果外科医生决定进行此类手术，必须尽量减少手术操作，因此应完全避免张力。显微外科手术提供了在神经内部进行操作的工具，而不会受到强烈组织反应的不良影响。对于连续性损伤问题，可以采用一种有区别的方法，允许独立评估大的束状结构或束组，而不是对整个神经干进行较为笼统的评估。
