The advent of microsurgery has in the last few decades considerably improved the results of treatment of lesions of nerves in the wrist and the hand, both with regard to functional restoration of sensation and movement and to reduction of local
irritant factors or those linked to
cold injury. Peripheral nerves are frequently injured at the wrist and the hand by
contusion, compression, straining or total or partial section. In the case of wrist, hand or finger
wound, only well-directed, precise and systematic clinical examination can determine the neurological deficit. Surgery is always indicated. There are often associated complex lesions, and all injured elements must be completely repaired. The order of this repair is always the same: tendons, nerves, then vessels. Concerning nerves,
therapy depends on the severity of the
contusion and (or) the loss of substance. If the section is distinct, direct
suture with physiological tension can be made. On the other hand, if there is
contusion or loss of substance, direct
suture cannot be performed since nonphysiological tension leads to endoneural ischaemia and
fibrosis. Rather, the extremities should be brought closer together in order to avoid retraction and subsequent secondary
sutures or short grafts should be made.