Age does not affect the outcome after digital nerve repair in children – A retrospective long term follow up

2017 ◽  
Vol 22 (5) ◽  
pp. 915-918 ◽  
Author(s):  
Hans-Eric Rosberg ◽  
Derya Burcu Hazer Rosberg ◽  
Illugi Birkisson ◽  
Lars B. Dahlin
Keyword(s):  
Nerve Repair ◽  
Digital Nerve ◽  
Long Term Follow Up

scholarly journals Long-Term Outcomes of Digital Nerve Repair Accompanied by Digital Artery Injury in Flexor Zone 2

2019 ◽  
Vol 06 (01) ◽  
pp. e7-e9
Author(s):  
Gokce Yildiran ◽  
Mustafa Sutcu ◽  
Osman Akdag ◽  
Zekeriya Tosun
Keyword(s):  
Blood Flow ◽  
Blood Supply ◽  
Nerve Repair ◽  
Arterial Injury ◽  
Digital Artery ◽  
Digital Nerve ◽  
Significant Difference ◽  
Sensory Recovery

Abstract Objectives Better healing results of any tissue or area is closely linked with a well-blood supply in reconstructive surgery. Peripheric nerve healing is closely related to blood supply as well. We aimed to assess whether there was any difference between digital nerve healing with and without extrinsic blood supply. Methods We assessed 48 patients with unilateral digital nerve injury at zone 2. Twenty-four of them had unrepairable arterial injury and other 24 had no arterial injury. The 24 patients in the “unrepaired artery group” (UA) and 24 patients in the “intact artery group” (IA) were compared. Results Mean follow-up time was 17.7 months. The mean two-point discrimination (2PD) was 5.29 mm in IA group and 5.37 mm in UA group. One neuroma in IA group and two neuromas in UA group were determined. We found no statistically significant difference between these groups in terms of neuroma, 2PD, and cold intolerance. The results of British Medical Research Council sensory recovery clinical scale were comparable for these two groups. Conclusion Digital nerve healing is related to numerous factors. We hypothesized that blood flow may be one of these factors; however, at this zone digital artery repair is not the foremost determinant for digital nerve healing. Further researches should be done for upper injury levels. Despite this result, we argue not to leave the digital artery without repairment and we propose to repair both artery and nerve to achieve the normal anatomical integrity and to warrant finger blood flow in possible future injuries.

scholarly journals First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up

2017 ◽  
Vol 42 (3) ◽  
pp. E2 ◽  
Author(s):  
Zachary C. Gersey ◽  
S. Shelby Burks ◽  
Kim D. Anderson ◽  
Marine Dididze ◽  
Aisha Khan ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Sural Nerve ◽  
Gunshot Wound ◽  
Nerve Repair ◽  
Nerve Graft ◽  
Sensory Function ◽  
Long Term Follow Up

OBJECTIVE Long-segment injuries to large peripheral nerves present a challenge to surgeons because insufficient donor tissue limits repair. Multiple supplemental approaches have been investigated, including the use of Schwann cells (SCs). The authors present the first 2 cases using autologous SCs to supplement a peripheral nerve graft repair in humans with long-term follow-up data. METHODS Two patients were enrolled in an FDA-approved trial to assess the safety of using expanded populations of autologous SCs to supplement the repair of long-segment injuries to the sciatic nerve. The mechanism of injury included a boat propeller and a gunshot wound. The SCs were obtained from both the sural nerve and damaged sciatic nerve stump. The SCs were expanded and purified in culture by using heregulin β1 and forskolin. Repair was performed with sural nerve grafts, SCs in suspension, and a Duragen graft to house the construct. Follow-up was 36 and 12 months for the patients in Cases 1 and 2, respectively. RESULTS The patient in Case 1 had a boat propeller injury with complete transection of both sciatic divisions at midthigh. The graft length was approximately 7.5 cm. In the postoperative period the patient regained motor function (Medical Research Council [MRC] Grade 5/5) in the tibial distribution, with partial function in peroneal distribution (MRC Grade 2/5 on dorsiflexion). Partial return of sensory function was also achieved, and neuropathic pain was completely resolved. The patient in Case 2 sustained a gunshot wound to the leg, with partial disruption of the tibial division of the sciatic nerve at the midthigh. The graft length was 5 cm. Postoperatively the patient regained complete motor function of the tibial nerve, with partial return of sensation. Long-term follow-up with both MRI and ultrasound demonstrated nerve graft continuity and the absence of tumor formation at the repair site. CONCLUSIONS Presented here are the first 2 cases in which autologous SCs were used to supplement human peripheral nerve repair in long-segment injury. Both patients had significant improvement in both motor and sensory function with correlative imaging. This study demonstrates preliminary safety and efficacy of SC transplantation for peripheral nerve repair.

scholarly journals Patient outcome after surgical management of the spinal accessory nerve injury: A long-term follow-up study

2016 ◽  
Vol 4 ◽  
pp. 205031211664573 ◽  
Author(s):  
Harry Göransson ◽  
Olli V Leppänen ◽  
Martti Vastamäki
Keyword(s):  
Nerve Repair ◽  
Trapezius Muscle ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Shoulder Abduction ◽  
Spinal Accessory ◽  
Long Term Follow Up ◽  
Direct Nerve

Objectives: A lesion in the spinal accessory nerve is typically iatrogenic: related to lymph node biopsy or excision. This injury may cause paralysis of the trapezius muscle and thus result in a characteristic group of symptoms and signs, including depression and winging of the scapula, drooped shoulder, reduced shoulder abduction, and pain. The elements evaluated in this long-term follow-up study include range of shoulder motion, pain, patients’ satisfaction, delay of surgery, surgical procedure, occupational status, functional outcome, and other clinical findings. Methods: We reviewed the medical records of a consecutive 37 patients (11 men and 26 women) having surgery to correct spinal accessory nerve injury. Neurolysis was the procedure in 24 cases, direct nerve repair for 9 patients, and nerve grafting for 4. Time elapsed between the injury and the surgical operation ranged from 2 to 120 months. The patients were interviewed and clinically examined after an average of 10.2 years postoperatively. Results: The mean active range of movement of the shoulder improved at abduction 44° (43%) in neurolysis, 59° (71%) in direct nerve repair, and 30° (22%) in nerve-grafting patients. No or only slight atrophy of the trapezius muscle was observable in 75%, 44%, and 50%, and no or controllable pain was observable in 63%, 56%, and 50%. Restriction of shoulder abduction preceded deterioration of shoulder flexion. Patients’ overall dissatisfaction with the state of their upper extremity was associated with pain, lower strength in shoulder movements, and occupational problems. Conclusion: We recommend avoiding unnecessary delay in the exploration of the spinal accessory nerve, if a neural lesion is suspected.

scholarly journals Retrospective Study of Surgical Repair of Gunshot Injuries of Peripheral Nerves.

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Ridvan Alimehmeti ◽  
Gramoz Brace ◽  
Ermira Pajaj ◽  
Arba Cecia ◽  
Thoma Kalefi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Brachial Plexus ◽  
Peripheral Nerves ◽  
Surgical Repair ◽  
Nerve Repair ◽  
Locomotor Apparatus ◽  
Severity Of Injury ◽  
Long Term Follow Up

Background: Shotgun injuries of the peripheral nerves are presented frequently during the last decades at the Service of Neurosurgery of UHC “Mother Theresa” in Tirana. In such cases the surgical repair of brachial plexus and peripheral nerves constitutes a challenge with relation to difficulties related with mechanism of injury, coexistence of other vascular damage, bone, soft tissue and visceral lesions. Materials and methods: A retrospective study of operated cases with shotgun injuries treated in our Department from 1997 to 2012 was conducted getting information from clinical charts, surgical registries, intraoperative photos and videos of the surgical repair of peripheral nerves. We performed a thorough analysis of the most influencing factors of surgical outcome such as: age, severity of injury, site of injury with relation to the innervated muscles, type of necessary nerve repair, presence of causalgia before operation, concomitant compromise of vascularization and/or locomotor apparatus. Follow-up of the patient was conducted through out-patient visits and phone interviews going back 10 years from surgical repair. Results: 68 cases operated for shotgun injury of brachial plexus or peripheral nerves were revised. There were different ages and both sexes involved. The type of nerve repair went from interfascicular neurolysis to direct end-to-end microsuture and nerve grafting. Timely repair of the nerve injury proved to be yielding better result than late repair in terms of pain relief and sensory motor improvement of the preoperative neurological deficit. The degree and the quality of improvement after surgery is related to the type of repair (neurolysis improves better and faster than grafting), the distance from site of injury to the effector muscle (the longer the distance more time it takes for the function to recover). The recovery of the brachial plexus was followed up for many years and further surgery proved to be necessary and of further improvement. Conclusions: From our long term experience dealing with surgical repair of shotgun injury of peripheral nerves we have learnt that early surgical repair is more efficacious in treating pain and gives better results in terms of motor and sensitive recovery than six months after injury as it was usually done. Long term follow-up is necessary to help with further surgery in case of distal decompressive surgery in anatomical tunnels.

Long-Term Follow-Up Study of Peripheral Nerve Repair by Non-Nerve Tissues

1996 ◽  
Vol 21 (6) ◽  
pp. 830-830
Author(s):  
J-C. Liu
Keyword(s):  
Peripheral Nerve ◽  
Nerve Repair ◽  
Muscle Membrane ◽  
Peripheral Nerve Repair ◽  
Muscle Graft ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
Empty Tube

This paper reported a long-term follow-up of seven cases (eight nerves) with peripheral nerve repair by non-nerve tissues. The injured nerves involved three median, two radial, one ulnar and one tibial nerves. These patients were treated 3 to 10 months after injuries. In five cases, pedicled muscles grafts were used to repair nerve gaps from 3 to 6 cm. Follow-up between 4 years and 10 months and 6 years and 8 months showed functional recovery ranged from MOS1 to M2 + S3. Two cases of nerve gaps 3 and 4 cm in length repaired by empty muscle membrane tubes recovered to M3S4 and M4S4. Liu concluded that pedicled muscle graft is not an ideal substitute for nerve graft. They peculated that inner structures in the muscle graft prevented growth of regenerating axons, which made the graft not function as effectively as an empty tube. One should be cautious in using non-nerve tissues to repair peripheral nerve gaps.

Dupuytren’s Disease Treated by Palmar Fasciectomy and an Open Palm Technique

1996 ◽  
Vol 21 (4) ◽  
pp. 484-485 ◽  
Author(s):  
D. L. SHAW ◽  
D. I. WISE ◽  
W. HOLMS
Keyword(s):  
Nerve Injury ◽  
Long Term Results ◽  
Continuous Series ◽  
Digital Nerve ◽  
Range Of Movement ◽  
Survivorship Analysis ◽  
Total Range ◽  
Long Term Follow Up

The results of long-term follow-up (range 9–19 years) are presented in a continuous series of patients treated for Dupuytren's contracture by one surgeon using the open palm technique. Mean preoperative total range of movement was 48% rising to 96% postoperatively. Mean total range of movement was 92% at follow-up. Survivorship analysis revealed 86% survival at 10 years and 77% survival at 19 years. There was one digital nerve injury and one case of algodystrophy. This technique gives good long-term results without the use of night splintage or physiotherapy.

The Long Term Result of Digital Nerve Repair in No-Man’s Land

1992 ◽  
Vol 17 (1) ◽  
pp. 75-77 ◽  
Author(s):  
B. S. GOLDIE ◽  
C. J. COATES ◽  
R. BIRCH
Keyword(s):  
Average Length ◽  
Nerve Repair ◽  
Electrical Conductance ◽  
Sensory Threshold ◽  
Digital Nerve ◽  
Long Term Result ◽  
Microsurgical Techniques ◽  
No Man's Land

30 isolated lesions of digital nerves which had been repaired by microsurgical techniques were examined in 27 patients. The average length of follow-up was 25 months (range: 12–48 months). Patients were assessed subjectively using a visual analogue scale and examined for light touch, pain, two-point discrimination, electrical conductance and sensory threshold. Although 37% of fingers regained normal two-point discrimination, only 27% of patients graded their overall result as excellent and 40% complained of persistent hyperaesthesia for up to two years. None felt that their finger had regained normal sensation. All patients undergoing digital nerve repair should be warned that hyperaesthesia may persist for several years and that an adult will never regain normal sensation.

Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis
Keyword(s):  
Mental Health ◽  
Mental Disease ◽  
Brain Disorders ◽  
Social Stressors ◽  
Labor Education ◽  
Mental Diseases ◽  
Long Term Follow Up ◽  
Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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