Early and Late Repair after High-level Peripheral Nerve Injury in the Upper Extremity.

Background: There are several methods developed for the treatment of high-level peripheral nerve injury (HLPNI) in the upper extremity. However, it causes significant loss of motor functions and sensory defects for the patients, and it is a challenging topic for surgeons. The purpose of our study is to analyze patient characteristics and long-term results of early and late repair of the HLPNI in the upper extremity. Patients and Methods: Patients who were operated from January 2016 to January 2022 due to HLPNI in the upper extremity are included. The characteristics of the patients, which are gender, age, affected nerve, time frame from the injury to operation time, mechanism of injury, whether nerve grafts are used during surgery, and mean follow-up time, are evaluated. Long-term functional results are assessed according to the British Medical Research Council scale during follow-up examinations. Results: The study included 24 patients, and the majority were male (79.1%). Sixteen patients were injured with sharp objects (66.6%). 41.6% of the patients are operated within 72 h after admission to the emergency room, whereas 58.4% of them are operated on after the outpatient clinic admission. The mean motor and sensory results of the patients who operated within the first 72 h after injury were M3S3+. The mean motor and sensory results of the patients who were operated on 72 h-1 month after the injury were M3S3, and for the patients who were operated on 1-5 months after the injury, the mean motor and sensory result was M2S2. The results of the injuries due to sharp objects were M3S3, whereas it was M2S2 for the patients who have been injured due to blunt trauma or firearms. Results of the patients under 20 years old were M3S3+; it was M3S2+ for the 20-50-year-old patients, whereas it was M2S2 for the patients older than 50 years old. Conclusion: Early repair is suggested for the HLPNI in the upper extremity, and gross motor function of the upper extremity is regained better, especially in young patients. Nerve graft necessity should be considered for the late repair. Early repair and secondary nerve repair with nerve graft are not always disappointing for the patient and the surgeon. [ABSTRACT FROM AUTHOR]