Management of Nerve Trauma in the Mangled Extremity

In this review, we present a principled approach to surgical management of nerve injuries in the mangled extremity. We discuss initial evaluation of the mangled extremity, key considerations with respect to surgical planning and timing, and current options for restoration of function including nerve repair, interposition grafts, nerve transfers, and other adjunctive techniques. Significant advances have been made in nerve transfer techniques, providing another option for restoration of function in extremity nerve injury. Management of nerve injuries in the mangled extremity is a challenging endeavor that requires significant planning and consideration by the nerve surgeon. Optimal recovery of function necessitates careful selection of the most appropriate surgical option for a given patient.