Current principles in microsurgical nerve repair

Micronerve reconstruction of motor and sensitive nerves in the head and neck area currently has an established range of indications. Surgical procedures always follow a strict order, beginning with external neurolysis. In cases of complete separation of the nerve stumps or when tensionless coaptation of nerve ends can not be achieved, nerve grafts from suitable donor sites, for example the sural nerve, have to be interposed. Good functional results can be obtained following reconstruction of motor nerves, as with the accessory or the facial nerve. In contrast, reconstruction of sensory nerves has a lower success rate but very often leads to a subjective improvement of symptoms for the patient. In long-standing facial palsy with atrophy of the facial musculature, neurovascularly reanastomosed muscle grafts offer a good option.