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In-Depth Information
Glove System” (
Rosen & Lundborg, 2007
). By using such a system, initiated
early after surgery, with sensory reeducation and compared with the con-
ventional sensory reeducation, which usually starts about 3 months postop-
eratively, tactile gnosis can significantly be improved (
Rosen & Lundborg,
2007
). Thus, even the brain can be utilized in the concept of timing after
nerve injury and repair and reconstruction (
Rosen & Lundborg, 2004
).
In conclusion, the functional outcome after nerve injury and repair and
reconstruction is dependent on a broad spectrum of different factors and the
results cannot be improved by focusing on one of these factors. Therefore,
we have to optimize the whole treatment strategies and improve every single
part of the whole treatment chain. One of these components is the timing of
nerve repair and reconstruction. This component is dependent on that the
surgeon makes an early and proper diagnosis of the nerve injury. If a com-
plete nerve injury is suspected, a prompt nerve repair should be done—a
statement that is strongly based on recent knowledge about neurobiology.
Any delay of the repair or reconstruction leads to a deterioration of the con-
dition of the different cells in the distal nerve segment, particularly the
important Schwann cells. The judgment of the extent of injury can be dif-
ficult in some specific cases, like in closed nerve injuries and gunshot and
shrapnel injuries, where nerve function is impaired, but the continuity of
the nerve is preserved. In such cases, one may consider waiting with any
tentative surgical procedure of the nerve trunk, but it is of outmost im-
portance that the surgeon in such cases has an attitude of “active surveil-
lance.” Thus, the surgeons should evaluate nerve function often and
repeatedly. If no signs of functional recovery are observed, the decision
of a nerve reconstruction procedure should not be further delayed. The
concept of timing does also include an early rehabilitation of the patient,
utilizing the new treatment algorithm after nerve repair and reconstruction.
Timing of nerve repair and reconstruction after nerve injury is one, but only
one in a long chain, key factor to improve functional outcome.
ACKNOWLEDGMENTS
The author's research has been supported by grants from Swedish Research Council
(Medicine), Lund University, EU grant (HEALTH-F4-2011-278612 BIOHYBRID),
Region Sk
˚
ne, The Swedish Society for Medicine, Promobilia, HKH Kronprinsessan
Lovisa's Fund, and Lundgren's Fund.
This chapter is dedicated to my close friend and research colleague Professor Martin
Kanje, who passed away in March 2013. Unfortunately, he could not see this chapter in
which he should have been a coauthor, but my work is dedicated to him and his
memory. Thank you Martin for all our fantastic and stimulating discussions!
