Severe Median nerve injury by firearm

Dear Ask The Doctor: I got shot. My median nerve was cut. Now my skin is shinny, smooth, numb, wont sweat and wont wrinkle in water. I got a blister on my finger. It was popped by my girlfriend. The skin never got wet because it couldn't sweat. So it dry healed- now its hard and im wondering if it will be like that forever. Will my nerve graft help the skin when the nerve reaches it? Will it sweat and get elastic again? I have good blood flow the only problem is the nerve... Will my skin go back to normal? Was my doctor lame in waiting 5 months to do the nerve graft since he never looked at the other doctors reports that said the nerve was cut...so he had me get tests for 4 months? Will i lose my thumb? Im in Munich, Germany for 3 years....what should i do?

Dear Brandon: Peripheral nerve injury  can cause symptoms of pain, dysesthesias, and either partial or complete loss of sensory and motor function. A thorough clinical history, physical examination, electrodiagnostic evaluation, and relevant radiographic studies should be performed , in addition, early neurosurgical consultation should be performed.  The severity or grade of a peripheral nerve injury is determined by the magnitude and duration of the applied forces of injury: 1.-Neuropraxia, the mildest grade of nerve injury, usually reversible and a full recovery can occur within days to weeks;  2.-Axonotmesis represents a more severe grade of nerve injury and is characterized by interruption of the axons with preservation of the surrounding connective tissue "highway" which can support axonal regeneration. As a general rule, peripheral nerve fibers regenerate at a rate of approximately 1 mm per day or 1 inch per month. Therefore, more proximal injuries require longer time intervals for regenerating axons to reinnervate their targets; 3.-Neurotmesis is the severest grade of peripheral nerve injury. Neurotmetic injuries are characterized by disruption of the axon, myelin, and connective tissue "highway" components of the nerve. Therefore, recovery through regeneration cannot occur. Since the necessary "highways" for axonal regeneration are absent, surgery is required to remove any intervening roadblocks in the form of scar tissue as well as to re-establish continuity of the nerve. Complete nerve injuries produce severe muscle denervation and may represent either an axonotmetic or neurotmetic grade of injury. It is critical to distinguish between these two grades of injury over time, since the latter requires a surgical repair for recovery to occur. Muscles should be reinnervated within two years following a traumatic nerve injury if recovery of useful motor function is to occur. Beyond this point, denervated muscles undergo irreversible atrophy and replacement with fat. Therefore, it is necessary to time a surgical exploration so that a successful nerve repair results in muscle reinnervation within two years of the injury. A useful rule of thumb is to follow a patient for 3 to 4 months to allow any element of neurapraxia to resolve as well as permit axonal regeneration to occur beyond the point of injury. If there is no clinical or electrodiagnostic evidence of muscle reinnervation, then a surgical exploration using intraoperative electrophysiological monitoring should be performed.