Sensory re-education

Repair of injured peripheral nerve trunks in the hand and upper extremity still represents one of the most challenging surgical constructive problems. In adults, discriminative sensory functions of the hand do not usually recover despite use of microsurgical repair techniques. A major reason for the imperfect outcome is the pronounced functional cortical reorganizations that occur after nerve injury, leading to a change of the normal hand representation into a disbursed pattern. A relearning process is required. Evolving principles for sensory relearning are based on the multimodal plasticity of the brain and rapid and long-term synaptic changes induced by extrinsic influence.