Post operative, conservative and surgical alternatives techniques for peripheral nerves injuries

The effects of chronic axotomy and muscle denervation render the tissue environment suboptimal for successful axonal regeneration. Muscle fibrosis and atrophy begins immediately after denervation and plateaus after 4 months when 60-80% of muscle volume has been lost. Motor endplates actually increase within muscle but functionnal reinnervation is unlikely beyond 12 months due to the progressive fibrosis.The failure of functional recovery is not only due to irreversible atrophy of muscle targets and their replacement by fat : animal experiments indicates that it is the progressive failure of the neurons and Schwann cells to sustain axon regeneration over distance and time.

The timeframe for reinnervation of sensory receptors is much longer than that for motor nerves but earlier repair still results in better sensory outcomes. Sensory receptors can be reinnervated years after injury but the maximum timeframe remains uncertain.

Therefore, the maximum should be done to retard the deleterious effects of denervation or to find therapeutic alternatives. This can be achieved by physiotherapy, and conservative and surgical alternatives to neurorrhaphy. [...]