Nerve and Vessel (arteries and veins) lacerations about the hand require repair with microsurgical techniques that involve the use of magnification with a microscope, special instruments called jewelers instruments and very fine suture that cannot be handled by the naked eye. The use of a microscope results in accurate repairs and excellent functional outcomes. These techniques require a fellowship in special microsurgery training done in many hand surgery programs. Although a plastic surgeon has microsurgical training, they are not trained to fix or reconstruct complex injuries requiring, bone, tendon, nerve, artery, and vein repairs. This holds true for orthopedic surgeons and general surgeons.
A nerve repair will take approximately 4 weeks for the new axons (nerve fibers) to cross the line of repair and then continues advancing at a pace of approximately 1 mm a day. Therefore, if a nerve laceration that has occurred at 10 cm proximal to the final target organ, will take approximately 100 days plus 30 more days from crossing the repair line for a total of 130 days to reach the final target organ and regain full function. The outcome for nerve repair is influenced by technical factors including; a tension free repair, proper fascicular alignment, appropriate bed, age less than 35 years, health status and smoking habits amongst others.
A vessel repair or reconstruction can be done with several techniques; however, the principles of microvascular surgery should be followed. The average percentage of success in small vessels is 95- 97 %. Patients that have had a vessel repair may have to remain in the hospital for 5 days with blood thinners and other measures to help the vessel repair remain patent.
The nerves and vessels once repaired will require of initial protection in a splint followed by early, progressive and carefully supervised motion by a hand therapist. Therapy geared to nerve repairs will include other different modalities such as nerve glide exercises, desensitization, neuromuscular re-education, bio-feedback, functional electric stimulation, sensory re-education, strengthening and splinting as indicated.