Although the management of such lesions is best delegated to specialized neurosurgeons, several aspects involve the neurologist. Surgical advances have allowed the successful apposition of severed nerve ends. The current recommendation is that end-to-end suturing of the stumps within 72 h should be undertaken to repair a sharp and clean division. In cases where the nerve is found on exploration to be bluntly severed with ragged ends, most surgeons recommend tacking the free ends to adjacent connective tissue planes and attempting the repair in 2 to 4 weeks. Most injuries, however, are blunt and retain some continuity of the nerve. If such continuity across the traumatized region can be demonstrated by electrophysiologic examination, operation is unnecessary. In the absence of improvement in the clinical and electrophysiologic features after several months (up to 6 months for plexus lesions), surgical repair may facilitate limited healing. Pain that appears months or years after injury suggests the development of a neuroma at the site of nerve section; a Tinel sign at that site aids in identifying this problem.
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