Protective Dorsal Blocking Splint

Dorsal Blocking Splint

Figure 20—4. Dorsal block splint for protection of repair in a multiple nerve lacerated hand with digital flexion begun and an early range-of-motion program.

Figure 20—4. Dorsal block splint for protection of repair in a multiple nerve lacerated hand with digital flexion begun and an early range-of-motion program.

Postoperative Management

Splinting is done for a period of 3 weeks (Fig. 20—4), but one sequela can be stiffness in the interphalangeal joints. Absent undue tension on the repair and full extension, range-of-motion exercises can be started at the time of suture removal or earlier depending on the quality of the repair.

Hand therapy following nerve repair is individualized, and many patients require no specific therapy. If stiffness does develop, supervised hand therapy and dynamic therapy are useful interventions.

Regeneration of the nerve is followed by measuring the paresthesia radiating distally from the level of nerve repair when the nerve is percussed (Tinel's sign). As regeneration continues, the focus of the paresthesia migrates distally. As migration and healing continue, sensibility is noted proximal to Tinel's sign.

Complications

Nerve surgery has complications similar to those found in other kinds of surgeries. Among the more common of these are infection, hematoma, seroma, and injury to surrounding structures, including vascular structures. Of unique concern during nerve surgery is the possibility of downgrading function by further injuring the nerve, particularly in mixed nerve injuries.

Suggested Readings

Allan CH. Functional results of primary nerve repair. Hand Clin 2000;16:67-72.

Birch R, Raji AR. Repair of median and ulnar nerves. Primary suture is best. J Bone Joint Surg 1991;73B:154-157.

Cabaud HE, Rodkey WG, Nemeth TJ. Progressive ultrastructural changes after peripheral nerve transection and repair. J Hand Surg 1982;7A:353-365.

Chow JA, Van Beek AL, Meyer DL, Johnson MC. Surgical significance of the motor fascicular group of the ulnar nerve in the forearm. J Hand Surg 1985;10A:867-872.

de Medinaceli L, Prayon M, Merle M. Percentage of nerve injuries in which primary repair can be achieved by end-to-end approximation: review of 2,181 nerve lesions. Microsurgery 1993;14:244-246.

ACUTE NERVE LACERATION| Diao E, Vannuyen T. Techniques for primary nerve repair. Hand Clin 2000;16:53-66.

Fu SY, Gordon T. Contributing factors to poor functional recovery after delayed nerve repair: prolonged denervation. JNeurosci 1995;15:3886-3895.

Hobbs RA, Magnussen PA, Tonkin MA. Palmar cutaneous branch of the median nerve. J Hand Surg 1990;15A:38-43.

Jabaley ME. Techniques in nerve repair. In: Hunter JM, Schneider LH, eds. Tendon and Nerve Surgery in the Hand: A Third Decade. St. Louis: Mosby; 1994:89-94.

Jarvik JG, Kliot M, Maravilla KR. MR nerve imaging of the wrist and hand. Hand Clin 2000;16:13-24.

Lundborg G, Dahlin LB, Danielsen N, et al. Nerve regeneration across an extended gap: a neurobiological view of nerve repair and the possible involvement of neu-ronotrophic factors. J Hand Surg 1982;7A:580-587.

Millesi H. Techniques for nerve grafting. Hand Clin 2000;16:73-91.

Smith KL. Anatomy of the peripheral nerve. In: Hunter JM, Schneider LH, eds. Tendon and Nerve Surgery in the Hand: A Third Decade. St. Louis: Mosby; 1994: 11-18.

Vanderhooft E. Functional outcomes of nerve grafts for the upper and lower extremities. Hand Clin 2000;16:93-104.

Wilgis EF, Brushart TM. Nerve repair and grafting. In: Green DP, ed. Operative Hand Surgery. Vol. 2. New York: Churchill Livingstone; 1993:1315-1340.

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    What is a dorsal blocking splint?
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