The Role of Timing in Nerve Reconstruction - International Review of Neurobiology - page 148

CHAPTER SEVEN

The Role of Timing in Nerve
Reconstruction

Lars B. Dahlin 1
Department of Clinical Sciences in Malm¨/Hand Surgery, Lund University, Sk˚ne University Hospital,
Malm¨ , Sweden
1 Corresponding author: e-mail address: [e-mail]

Contents
1. The Intrinsic Response in Neurons and Schwann Cells After Injury 152

2. The Timing of Nerve Repair and Reconstruction 156

3. Cerebral Plasticity The Importance of Timing in Rehabilitation 160

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Acknowledgments 161

References 162

Abstract
The surgeon, who treats nerve injuries, should have knowledge about how peripheral
nerves react to trauma, particularly an understanding about the extensive pathophys-
iological alterations that occur both in the peripheral and in the central nervous system.
A large number of factors influence the functional outcome, where the surgeon only
can affect a few of them. In view of the new knowledge about the delicate intracellular
signaling pathways that are rapidly initiated in neurons and in nonneuronal cells with
the purpose to induce nerve regeneration, the timing of nerve repair and reconstruction
after injury has gained more interest. It is crucial to understand and to utilize the inborn
mechanisms for survival and regeneration of neurons and for activation, survival, and
proliferation of the Schwann cells and other cells that are acting after a nerve injury.
Thus, experimental and clinical data clearly point toward the advantage of early nerve
repair and reconstruction of injuries. Following an appropriate diagnosis of a nerve
injury, the nerve should be promptly repaired or reconstructed, and new rehabilitation
strategies should early be initiated. Considering nerve transfers in the treatment arsenal
can shorten the time of nerve reinnervation of muscle targets. Timing of nerve repair
and reconstruction is crucial after nerve injury.

A nerve injury has a severe impact on the individual patient, who may expe-
rience a broad spectrum of symptom after injury, including sensory dysfunc-
tion, lack of muscle function, pain, allodynia, and cold sensitivity. These
symptoms, with a profound impact on the patient's global hand and arm
function, do not only cause individual suffer to the patient but can also