The following are my indications for deciding to operate after an injury that has damaged nerve function:

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The aim of the operation is to preserve or restore function. This is achieved by preserving or restoring the inflow and outflow innervation of the skin, muscle, soft tissues, skeleton, and other target organs.

  • Complete loss of nerve function after a wound over the course of a major nerve
  • Complete loss of nerve function affecting a nerve after surgery or an injection near that nerve
  • Complete loss of nerve function after a closed injury, especially high-energy injuries with severe damage to soft tissues and the skeleton
  • Complete loss of nerve function after closed traction injury of the brachial plexus
  • A nerve lesion associated with fracture or dislocation requiring urgent open reduction and internal fixation
  • Worsening of a nerve injury while under clinical follow up
  • Failure to progress toward recovery in the expected time after a closed injury
  • Failure to recover from conduction block within 6 weeks of injury
  • Persistent neuropathic pain resistant to nonoperative multimodal  management
  • Treatment of a symptomatic post traumatic neuroma
  • A nerve lesion associated with an arterial injury

Amended from Quick & Birch “Nerve injury” Chapter 30. Green’s Hand Surgery 7th Ed. 2016. Elsevier