Digital Nerve Grafting Using the Dorsal Sensory Branch of the Ulnar Nerve

1985 ◽  
Vol 10 (1) ◽  
pp. 37-40 ◽  
Author(s):  
T. L. GREENE ◽  
J. B. STEICHEN
Keyword(s):  
Ulnar Nerve ◽  
Hand Function ◽  
Nerve Graft ◽  
The Other ◽  
Nerve Grafting ◽  
Digital Nerve ◽  
Nerve Grafts ◽  
Neuroma Formation

The dorsal sensory branch of the ulnar nerve has been found to have the appropriate size and sufficient length for use as a digital nerve graft. This donor nerve was utilised fifteen times in twelve patients for the bridging of defects in thirteen digital nerves of the fingers. After an average follow-up of 23.2 months, only one patient failed to achieve any two point discrimination in the area supplied by the involved digital nerve. The other eleven patients had an average two point discrimination of 9.5 mm with a range of 5 to 18 mm. Painful neuroma formation or loss of hand function related to the use of the dorsal sensory branch of the ulnar nerve as a donor for digital nerve grafts was not encountered.

Vascularised Versus Conventional Nerve Grafting: A Case Report

1987 ◽  
Vol 12 (2) ◽  
pp. 218-220
Author(s):  
J. G. BOOBMAN ◽  
P. J. SYKES
Keyword(s):  
Case Report ◽  
Nerve Graft ◽  
The Other ◽  
Cutaneous Nerve ◽  
Nerve Grafting ◽  
Nerve Grafts ◽  
Sensory Recovery ◽  
Lateral Cutaneous Nerve

A case is described in which two lengths of the lateral cutaneous nerve of the forearm were used, one vascularised and the other not, to reconstruct the two digital nerves of the thumb. The sensory recovery of the two nerves was compared, and the vascularised nerve graft found to result in better sensation. This finding provides further support for the value of vascularised nerve grafts.

An Experimental Study of Contralateral C7 Root Transfer with Vascularized Nerve Grafting to Treat Brachial Plexus Root Avulsion

1994 ◽  
Vol 19 (1) ◽  
pp. 60-66 ◽  
Author(s):  
L. CHEN ◽  
Y-D. GU
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Phrenic Nerve ◽  
Nerve Transfer ◽  
Nerve Graft ◽  
Functional Evaluation ◽  
Nerve Grafting ◽  
Root Avulsion ◽  
Nerve Grafts ◽  
Healthy Side

Experimental rat models of simulated brachial plexus injuries were devised to compare the effect of contralateral C7 root transfer with phrenic neurotization. The effect of vascularized nerve grafting (VNG) was also compared with the use of conventional nerve grafts (CNG) in the treatment of root avulsion of the brachial plexus. 160 rats were randomly divided into four groups of 40 each; contralateral C7 root transfer with a vascularized ulnar nerve graft (C7-VNG), contralateral C7 root transfer with conventional ulnar nerve grafting (C7-CNG), ipsilateral phrenic nerve transfer with a vascularized ulnar nerve graft (P-VNG) and ipsilateral phrenic nerve transfer with conventional ulnar nerve grafting (P-CNG). Electrophysiological and histological examinations and functional evaluation were performed at different post-operative intervals. C7 root transfer was found to be superior to phrenic nerve transfer and VNG superior to CNG. Severance of the C7 nerve root was not found to affect limb function on the healthy side.

Prolonging Nerve Grafts Using Chemical Extracted Muscle-in-vein with Vein Window Method Chemical acellular nerve grafts

2018 ◽  
Vol 68 (12) ◽  
pp. 2936-2940
Author(s):  
Irina Mihaela Jemnoschi Hreniuc ◽  
Camelia Tamas ◽  
Sorin Aurelian Pasca ◽  
Bogdan Ciuntu ◽  
Roxana Ciuntu ◽  
...  
Keyword(s):  
Classical Group ◽  
Donor Site ◽  
Good Alternative ◽  
Nerve Graft ◽  
Male Rats ◽  
Chemical Extraction ◽  
Nerve Grafting ◽  
Nerve Grafts ◽  
Local Resources ◽  
Window Method

Nerve injuries are a common pathology in hand trauma. The consequences are drastic both for patients and doctors/medical system. In many cases direct coaptation is impossible. A nerve graft should be used in the case of a neuroma, trauma or tumor, for restoration of nervous influx. The aim of this study is demonstrate that by grafting restant nerve stumps with muscle-in-vein nerve grafts we obtain good result in terms of functional and sensibility recovery and also our method �window-vein� is a good way of prolonging nerve grafts. The method of study is experimental. We worked in the laboratory in optimal conditions for carrying out of muscles-in-vein nerve grafts (nerve grafts size 1.5 cm-3 cm). We used acellular muscle grafts with the chemical extraction method.The study was conducted on experimental animals (Wistar male rats).We used 30 experience animals in 3 equal groups (classical group and muscle-in-vein nerve grafts-2 nerve grafts of 1,5 cm central sutured and the third group with muscle-in-vein nerve grafts, window-vein method, 3 cm). At 4 and respectively 6 weeks postoperative at the quality tests we observed the progress with the footprint test. The operated hind in comparison with the healthy hind was 86% recovered and similar with classic nerve grafts. Quantitatively the number of regenerated axons in the group with muscle-in-vein nerve grafts was significant bigger in comparison with the classical group (15%).The method using muscle-in-vein nerve graft with windows-vein it�s a good alternative for nerve grafting in comparison with classical nerve grafting. When the local possibilities are limited, this method is good for prolonging the grafts. The relationship between cost and benefit in this case it�s an advantage because we use the local resources of the affected area. The motor results of nerve grafting ingroup 2 in comparison with group 3 were similar and in some cases better in group 1. Grafting with MVNG offers a better alternative for donor site regeneration in comparison with classical nerve grafts. This method is useful to prolong nerve grafts without adding morbidity.

Outcome of axillary nerve injuries treated with nerve grafts

2011 ◽  
Vol 36 (7) ◽  
pp. 535-540 ◽  
Author(s):  
M. Okazaki ◽  
A. Al-Shawi ◽  
C. R. Gschwind ◽  
D. J. Warwick ◽  
M. A. Tonkin
Keyword(s):  
Reliable Method ◽  
Axillary Nerve ◽  
Nerve Grafting ◽  
Nerve Injuries ◽  
Nerve Grafts ◽  
The Mean

This study evaluates the outcome of axillary nerve injuries treated with nerve grafting. Thirty-six patients were retrospectively reviewed after a mean of 53 months (minimum 12 months). The mean interval from injury to surgery was 6.5 months. Recovery of deltoid function was assessed by the power of both abduction and retropulsion, the deltoid bulk and extension lag. The deltoid bulk was almost symmetrical in nine of 34 cases, good in 22 and wasted in three. Grade M4 or M5* was achieved in 30 of 35 for abduction and in 32 of 35 for retropulsion. There was an extension lag in four patients. Deltoid bulk continued to improve with a longer follow-up following surgery. Nerve grafting to the axillary nerve is a reliable method of regaining deltoid function when the lesion is distal to its origin from the posterior cord.

scholarly journals Lateral Antebrachial Cutaneous Nerve as a Donor Source for Digital Nerve Grafting: A Concept Revisited

2017 ◽  
Vol 11 (1) ◽  
pp. 1041-1048 ◽  
Author(s):  
Mehmet Bekir Unal ◽  
Kemal Gokkus ◽  
Evrim Sirin ◽  
Eren Cansü
Keyword(s):  
Pearson Correlation ◽  
Mean Value ◽  
Cutaneous Nerve ◽  
Digital Nerve ◽  
Mean Values ◽  
Nerve Grafts ◽  
The Mean ◽  
The Difference ◽  
Mean Time

Objective: The main objective of this study is to evaluate the availability of lateral antebrachial cutaneous nerve (LACN) autograft for acute or delayed repair of segmented digital nerve injuries. Patients and Methods: 13 digital nerve defects of 11 patients; treated with interposition of LACN graft that harvested from ipsilateral extremity were included in the study. Mean follow up period was 35, 7 months. The mean time from injury to grafting is 53, 3 days. The results of the mean 2PDT and SWMT values of injured /uninjured finger at the end of follow up period were evaluated with Paired T test. The correlation between the defect length and the difference of 2PDT, SWMT values between the uninjured and injured finger at the end of follow up period; were evaluated with Pearson - correlation analysis. Results: The mean value of our 2PDT and SWMT results are ~5,923, ~3, 52, respectively in which can be interpreted between the normal and diminished light touch. The defect length and difference percentage of SWMT values is positively and significantly correlated statistically. Mean length of interposed nerve grafts was 18.5 mm. The age of the patient and the mean values of 2PDT and SWMT with the difference % of 2PDT and % of SWMT are not statistically correlated. Conclusion: Based on results regarding sensory regaining at recipient side and negligible sensory deficit at harvesting side, we suggest that lateral antebrachial cutaneous nerve might be a valuable graft option for digital nerve defects.

scholarly journals Isolated Intermetatarsal Ligament Release as Primary Surgical Management for Morton’s Neuroma

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0013
Author(s):  
Mohamed Abdelaziz ◽  
Kathryn Whitelaw ◽  
Gregory Waryasz ◽  
Daniel Guss ◽  
Anne Johnson ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Nerve Transection ◽  
Digital Nerve ◽  
Morton’S Neuroma ◽  
The Past ◽  
Symptom Exacerbation ◽  
Morton's Neuroma ◽  
Web Space ◽  
Neuroma Formation

Category: Midfoot/Forefoot Introduction/Purpose: While the precise pathoetiology of Morton’s neuroma remains unclear, nerve inflammation as a result of chronic entrapment from the overlying intermetatarsal ligament (IML) may play a role. Traditional surgical management involved common digital nerve transection with neuroma excision, but this procedure risks unpredictable formation of a stump neuroma and potential worsening of symptoms. Accordingly, the senior author has over the past six years espoused isolated IML release and common digital nerve decompression in lieu of nerve transection or neuroma excision as an alternative treatment strategy. We hypothesized that IML release offers effective pain relief and high patient satisfaction level as a surgical treatment for recalcitrant Morton’s neuroma without the risk of stump neuroma formation or symptom exacerbation. Methods: Medical records for all consecutive patients treated surgically with isolated single interspace IML release for symptomatic and recalcitrant Morton’s neuroma over a four year period at a large academic medical center were examined. Any adult patient with clinically diagnosed Morton’s neuroma who had failed at least three months of conservative treatment and who then underwent single-webspace IML decompression were included. Any patient who had less than three months postoperative follow up, had undergone revisional neuroma surgery, or had undergone additional procedures at the time of the IML release were excluded. Overall patient satisfaction as well as pre- and post-operative Visual Analog Pain Scale (VAS) assessments were recorded for all patients. Results: Eleven patients underwent isolated, single interspace IML decompression for Morton’s neuroma over this time frame. One of these patients had a neuroma localized to the second web space and 10 were localized to the third web space. Average follow-up was 10.8± 9 (3-32) months (Table 1). VAS pain scores averaged 6.4 ± 1.9 (4-9) preoperatively and decreased to an average of 1.5 ± 1.6 (0-5) at final follow up (P = 0.003). All patients reported significant pain improvement and an overall satisfaction with the procedure (would undergo it again). No patients returned to the operating room, there were no postoperative infection nor worsening of pain, and no other complications were reported. Conclusion: Isolated single interspace IML release of chronically symptomatic Morton’s neuroma shows promising short-term results regarding pain relief and overall patient satisfaction, with few complications and no demonstrated risk of recurrent neuroma formation, permanent numbness, or postoperative symptom exacerbation. The authors’ collective experience with this approach has been positive enough over the past six years to result in the entire abandonment of the practice of neuroma excision in this patient population.

scholarly journals Schwannoma in the Upper Limbs

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Chris Yuk Kwan Tang ◽  
Boris Fung ◽  
Margaret Fok ◽  
Janet Zhu
Keyword(s):  
Peripheral Nerves ◽  
Motor Nerve ◽  
Distal Region ◽  
Nerve Graft ◽  
Nerve Grafting ◽  
Nerve Grafts ◽  
Functional Deficit ◽  
Patient Consent ◽  
New System ◽  
Mixed Nerve

Schwannomas are the commonest tumours of peripheral nerves. Despite the classical description that schwannomas are well encapsulated and can be completely enucleated during excision, a portion of them have fascicular involvement and could not be completely shelled out. A retrospective review for 8 patients was carried out over 10 years. 75% of schwannoma occurred over the distal region of upper limb (at elbow or distal to it). It occurs more in the mixed nerve instead of pure sensory or motor nerve. 50% of patients had mixed nerve involvement. Fascicular involvement was very common in schwannoma (75% of patients). Removal of the tumour with fascicles can cause functional deficit. At present, there is no method (including preoperative MRI) which can predict the occurrence of fascicular involvement; the authors therefore proposed a new system to stratify patients who may benefit from interfascicular nerve grafts. In this group of patients, the authors strongly recommend that the possibility and option of nerve graft should be discussed with patients prior to schwannoma excision, so that nerve grafting could be directly proceeded with patient consent in case there is fascicular involvement of tumour found intraoperatively.

scholarly journals Sensory outcomes after repair of median and ulnar nerve with nerve graft

2021 ◽  
Vol 8 (3) ◽  
pp. 874
Author(s):  
Ankit Disawal ◽  
Sunil Srivastava
Keyword(s):  
Ulnar Nerve ◽  
Nerve Graft ◽  
Nerve Grafting ◽  
Nerve Reconstruction ◽  
Factors Affecting ◽  
British Medical Research Council ◽  
Appropriate Treatment ◽  
Significant Difference ◽  
Sensory Recovery ◽  
Graft Evaluation

Background: Peripheral nerve injuries in upper extremities are common. These injuries have significant impact on patient’s life. Appropriate treatment is important for patients to regain functional recovery.Methods: Study conducted on patients treated on Department of Plastic and Reconstructive surgery from January 2018 to May 2019. Study was done to evaluate the sensory recovery of median and ulnar nerve in the forearm after defects were repair by autologous nerve graft. Evaluation was performed in 24 patients. Rating of sensibility was presented by British medical research council scale. Satisfactory sensory recovery was defined as MRC grading S3+ and S4.Results: We evaluate the result of  median and ulnar nerve reconstruction as regards to factors affecting functionally the result of operation, which are age, injury level, graft level, and denervation time. Median nerve grafting done in 14 patients and sensory recovery S4 achieved in 2 patients (14%), S3+ in 4 patients (29%). Ulnar nerve grafting done in 10 patients and sensory recovery S4 achieved in 2 patients (20%), S3+ in 2 patients (20%). There was not statistically significant difference in sensory recovery of median and ulnar nerve. There was not statistically significant difference by age, level of injury, graft length, denervation time.Conclusions: There was no significant difference in sensory recovery of median and ulnar nerves. Mode of injury influences results. Results were comparatively better in younger patients and in patients who had undergone repair within shorter time. 

scholarly journals Donor nerve graft assessment for covering thumb nerve defects: a cadaveric study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Hamid Namazi ◽  
Ahmad Sobhani ◽  
Saeed Gholamzadeh ◽  
Amirreza Dehghanian ◽  
Fatemeh Dehghani Nazhvani
Keyword(s):  
Surface Area ◽  
Sural Nerve ◽  
Nerve Graft ◽  
Cutaneous Nerve ◽  
Digital Nerve ◽  
Cross Sectional ◽  
Nerve Grafts ◽  
Anterior Interosseous Nerve ◽  
The Mean ◽  
Graft Selection

Abstract Background Even though several studies reported donor autologous nerve grafts for digital nerve defects, there is no report in the literature regarding acceptable graft for thumb nerves. The purpose of this study is to provide guidelines for autologous nerve graft selection by detecting similarities between thumb nerve zones and donor nerve with regard to the number of fascicles and cross-sectional area. Materials and methods Five cadavers were used in this study. An anatomical zoning system was defined for thumb nerves (zones 1, 2, 3). Sural nerve (SN), medial antebrachial cutaneous nerve (MABCN), lateral antebrachial cutaneous nerve (LABCN), posterior interosseous nerve (PIN), and anterior interosseous nerve (AIN) were selected as donor nerve grafts. The number of fascicles and surface area (mm2) was defined. Results The mean of the fascicle number in zone 1, zone 2, zone 3, AIN, PIN, LABCN, MABCN, and SN were 3.8, 4.7, 6.1, 2.2, 1.8, 4.5, 3.1, and 6.4, respectively. The mean of the surface area in zone 1, zone 2, zone 3, AIN, PIN, LABCN, MABCN, and SN were 2.19, 6.26, 4.04, 1.58, 0.71, 5.00, 3.01, and 8.06, respectively. Conclusions LABCN is the best choice for all zones that has fascicular matching with all three zones of thumb nerves and caliber matching with zones 2 and 3. In zone 1, the best nerve graft is MABCN which has both suitable caliber and fascicle count.

scholarly journals Nerve Repair and Orthodromic and Antidromic Nerve Grafts: An Experimental Comparative Study in Rabbit

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Jihyeung Kim ◽  
Young Eun Choi ◽  
Jeong Hwan Kim ◽  
Seung Hak Lee ◽  
Sohee Oh ◽  
...  
Keyword(s):  
Action Potential ◽  
Tibial Nerve ◽  
Nerve Repair ◽  
Nerve Graft ◽  
The Other ◽  
Motor Action ◽  
Nerve Grafts ◽  
Compound Motor Action Potential ◽  
Significant Difference ◽  
Histologic Evaluation

Purpose. Although many surgeons have anecdotally described reversing the polarity of the autograft with the intent of improving regeneration, the optimal orientation of the autogenous nerve graft remains controversial. The aim of this study was to compare (1) the outcomes of orthodromic and antidromic nerve grafts to clarify the effect of nerve graft polarity and (2) the outcome of either form of nerve grafts with that of nerve repair. Methods. In 14 of the 26 rabbits used in this study, a 1 cm defect was made in the tibial nerve. An orthodromic nerve graft on one side and an antidromic nerve graft on the other were performed using a 1.2 cm long segment of the peroneal nerve. In the remaining 12 rabbits, the tibial nerve was transected completely and then repaired microscopically on one side but left untreated on the other. Electrophysiologic studies were performed in all animals at 8 weeks after surgery, and the sciatic nerves were harvested. Results. Compound motor action potential was visible in all rabbits treated by nerve repair but in only half of the rabbits treated by nerve graft. There was no significant difference in the compound motor action potential, nerve conduction velocity, or total number of axons between the orthodromic and antidromic nerve graft groups. However, in both groups, the outcome was significantly poorer than that of the nerve repair group. Conclusion. There was no significant difference by electromyographic or histologic evaluation between orthodromic and antidromic nerve grafts. Direct nerve repair with moderate tension may be a more effective treatment than nerve grafting.

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