A surgeon repairs two nerve injuries. Injury 1 is a clean razor laceration of the median nerve seen within hours. Injury 2 is a closed crush injury to the radial nerve with contusion of the nerve ends. What is the appropriate timing strategy for each?

• A Primary repair for both injuries
• B Primary repair for injury 1, delayed exploration and repair after 3 weeks for injury 2 ✓
• C Delayed repair at 3 months for both injuries
• D Primary repair for injury 2, delayed repair for injury 1

Explanation

A clean sharp transection with healthy viable stumps allows immediate primary epineurial repair with the best functional outcome. A crushed or contused nerve has an uncertain extent of internal damage that evolves over days to weeks, so early primary suturing risks coapting necrotic tissue. Delayed exploration at around 3 weeks allows demarcation of healthy fascicles, guided by intraoperative nerve action potentials if needed. Waiting 3 months for a clean laceration wastes regenerative time and invites stump retraction.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.