Invited Discussion

This paper has an interesting premise: based on the research of Terzis and Michelow,[1] it is hypothesized that intact afferent fibers adjacent to regions of denervation may supply adequate “compensatory” innervation by means of overlapping receptive fields and “sprouting” of new fibers off the adjacent intact fibers. This is in contrast to Dellon's belief,[2] that sensation is restored via a regenerative sequential process, which takes much more time. A method of therapeutic sensory re-education is discussed, based on the assumption that distal sensory perception in regions of denervation occurs by a compensatory, rather than a regenerative, process.

This significantly different view of sensory recovery subsequent to digital nerve repairs (all samples described were more distal repairs) warrants consideration. However, the size of their sample and the methods used to assess sensory function might be questioned. The common sensory phenomena seen over the course of time subsequent to peripheral nerve repair (dysesthesia, hypersensitivity, reduced sensory acuity) raise other questions about what appear to be clear effects associated with a regenerative process in the sensory fibers. Nevertheless, these authors have raised some interesting and thought-provoking issues.

REFERENCES

• 1 Terzis J K, Michelow B J. Sensory receptors. In: Gelberman RH, ed. Operative Nerve Repair and Reconstruction Philadelphia: JB Lippincott Company 1991: 85-105
• 2 Dellon A L. Re-education of sensation. In: Evaluation of Sensibility and Re-Education of Sensation in the Hand Baltimore: Williams & Wilkins 1981: 230