The History of Nerve Repair

Abstract

This brief review traces the history of peripheral nerve repair, from the nihilistic attitude of early Greek physicians, via the occasional Renaissance proponent of tension-free anastomosis of nerve stumps, and the centuries-long reluctance of most surgeons to intervene for fear of causing severe postoperative pain, to current clinical practice involving microsurgery. Although the need to treat nerve injuries sustained in battle has long been a major driver in the quest for effective treatment, the transition from empiricism to evidence-based practice has occurred relatively recently along this time line. Modern concepts of the structure of peripheral nerves and their cellular responses to traumatic injury evolved in the nineteenth century pari passu with the emergence of increasingly sophisticated microscopical and neurophysiological techniques. Defining the cellular and molecular events that occur after a nerve has been injured, whether by ischemia, crush, or transection, informs the current management of such injuries. Despite many decades of research, it is a sobering thought that functional outcomes after repair frequently remain unsatisfactory.