Timing of Nerve Repair: Acute versus Delayed

The timing of surgical nerve repair plays a pivotal role in optimizing functional recovery following peripheral nerve injury. This chapter will explore the physiologic basis of nerve regeneration, the impact of timing on axonal sprouting and target organ reinnervation, and the clinical factors influencing the decision between acute and delayed intervention. Emphasis will be placed on injury characteristics, associated trauma, patient comorbidities, and the reconstructive ladder. This chapter will provide surgeons with guidance on the timing of nerve repair, the utility of nerve grafts, and important considerations for acute and delayed repair. We will include injuries involving the hand and upper extremity, the brachial plexus, and nerve injuries with concomitant bone or vascular injury. Our evidence-based outline will hopefully reiterate important principles of nerve repair to help guide real-world practice.