1. Introduction
Peripheral nerves were first distinguished from tendons by Herophilus in 300 BC. By
meticulous dissection he traced nerves to the spinal cord, demonstrating the continuity of
the nervous system(1). In 900 AD, Rhazes made the first clear reference to nerve repair.
However, not until 1795 did Cruikshank demonstrate nerve healing and recovery of distal
extremity function after repair. In the early 1900s, Cajal pioneered the concept that axons
regenerate from neurons and are guided by chemotrophic substances. In 1945, Sunderland
promoted microsurgical techniques to improve nerve repair outcomes (1). Since that time,
there have been a number of advances and new concepts in peripheral nerve
reconstruction.
Research regarding the molecular biology of nerve injury has expanded the available
strategies for improving results. Some of these strategies involve the use of pharmacologic
agents, immune system modulators, enhancing factors, and entubulation chambers. A
thorough understanding of the basic concepts of nerve injury and repair is necessary to
evaluate the controversies surrounding these innovative new modalities (1,2).
Treatment of peripheral nerve injuries is considered as challenge procedure. In the past
there is no definite line of treatment. A lot of cases with peripheral nerve injuries either
missed the diagnosis or found no treatment. With the advent of microscope and
development of microsurgical instrument, the era of microsurgical nerve reconstruction has
been developed. Two lines of treatment for peripheral nerve injuries have been discussed in
the literatures and specialized books. The conservative treatment is one line and it was
widely used in the past. This line of treatment is mainly described for the non surgical
causes of peripheral nerve injuries. There are numerous causes of non surgical peripheral
nerve injuries as, metabolic, collagen diseases, malignancies, endogenous or exogenous
toxins, thermal, chemical, or nutritional. Surgical causes of peripheral nerve injuries include
acute and chronic causes. The acute surgical causes of peripheral nerve injuries mostly due
to simple bone fracture, open fracture, cut wound, traction injuries, firearm injuries (either
thermal effect or direct injury), crushed injuries, or animal bite injuries. The chronic surgical
causes of peripheral nerve injuries include either acute nerve injuries with formation of
painful neuroma or entrapment neuropathies.
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