Functional reconstruction of the extremities in cases with definitive peripheral nerve lesions

Deficit if the functional integrity of the limbs as a consequence of the definitive lesions of the peripheral nerves necessitates surgical treatment aimed at regaining of the optimal mobility and strength of the parts of the limbs or whole limbs. Our study was aimed at presenting our experience in functional reconstruction of the extremities, evaluation of significance of primary and delayed microsurgical reconstruction of the injured nerves with respect to further course of treatment and presenting innovative modifications of certain surgical techniques. The total of 101 surgical procedures were performed in 91 patients, out of which 76 were at the level of the shoulder, elbow and hand and 29 were on the feet. Depending on the local findings, the following techniques were applied: transposition of the muscles and tendons, transfer of the free microneurovascular muscle flaps and surgical fusion of the joints. Functional improvement was achieved in 98.7% of the cases. Increased range of movements and strength depended on the applied technique and preoperative findings. Primary and delayed microsurgical reconstruction of nerves increases the probability for choice of adequate surgical techniques. Muscle and tendon transfers are the methods of choice in most of the patients. Free microneurovascular muscle flaps are applied in the most complicated cases.