Five operations that don’t give the best results after peripheral nerve surgery

Despite advances in imaging, instrumentation, surgical techniques, and postoperative care, outcomes for certain peripheral nerve procedures remain consistently disappointing. In this article, we describe five surgical scenarios--adult pan-brachial plexus injuries, peroneal nerve injury after knee dislocation, sciatic nerve injury after total hip arthroplasty, radiation-induced brachial plexopathy, and lower trunk injury after cardiac surgery--that, in our experience and review of the literature, frequently lead to limited and consistently poor functional recovery after nerve surgery. These challenging cases reflect not only technical and anatomical complexity but the profound biological limitations of nerve regeneration in specific contexts. By critically analyzing these five procedures, we aim to promote more realistic patient counseling, support timely and individualized decision-making, and foster a more nuanced understanding of when and what type of surgical intervention may or may not be beneficial.