Clinical And Sequential Experimental Study On Denervated Muscle, Neuromuscular-junction And Functional Recovery After Early And Delayed Nerve Repair

It has been generally acknowledged that early repair of peripheral nerves would produce best results. But there is still intensive debate on whether primary or secondary suture of nerves can provide better opportunity for axonal growth. Rank, Wakefield and Hueston ( 1973 ) hold that primary suture of divided nerve produces the best results. Birch (1991) also supported their point of view. On the contrary , Ducker (1977) and Ellis (1985) found that early secondary repair was better than primary repair because of heightened metabolic activity in nerve cell body during this period of time. Dr.H.Millesi stated in 1981: Whether primery or secondary nerve repair offers a better chance at regeneration is still and will continue to be discussed. The basic question is whether a primary nerve repair has a real ad -vantage over a secondary one.For decades most outstanding orthopaedists hold that valuable results from repair of peripheral nerve injuries of more than one year duration cannot be expected due to irreversible changes of muscle, disappearance of motor end -plates and severe shrinkage of distal nerve endoneurial tubes and Schwann tubes, e.g. Birch(1986) claimed: Functional recovery in the hand cannot be expected if repair of an ulnar nerve lesion is performed over one year from injury; and if, after severance of the radial nerve, the delay before suture exceeds 18 months. Crenshaw with his each edition up to the last of Campbell' s Operative Orthopaedics adheres to this assertion.From our clinical study on primary and secondary repair in radial...