11.11 Surgical Techniques for Radial Nerve Repair

✓ This study assessed the changes that occurred in the spinal motoneuron pool after the repair of a specific peripheral nerve by means of several clinically appropriate surgical techniques: nerve graft, muscle graft, and epineurial suture. The motoneuron pool relating to a single muscle was assessed at 50, 100, 200, and 300 days after repair via retrograde axonal transport of the neural tracer horseradish peroxidase. The results indicate that although a small portion of the motoneuron population dies following peripheral nerve surgery, this is not a significant number. The majority of the anterior horn cells appear to have the ability to both survive nerve transection and form new functional connections with the regenerated nerve after repair. The degree of cell loss is influenced by the nature of the injury and the method of repair implemented. Injuries involving neurotmesis result in the loss of a greater proportion of the cell population than less severe injuries involving axonotmesis. A greater proportion of the motoneuron population is preserved when the severed nerve has been repaired using a direct epineurial suture than when repair is achieved by means of a graft. The two methods of grafting produced comparable results, although the muscle graft tended to result in the preservation of a greater number of cells than the nerve graft, making it an acceptable alternative method for the surgical repair of short gaps in peripheral nerves.

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73 Surgical Techniques for Peripheral Nerve Repair

Neurosurgical Operative Atlas: Spine and Peripheral Nerves ◽

10.1055/b-0037-144779 ◽

2017 ◽

Keyword(s):

Peripheral Nerve ◽

Nerve Repair ◽

Surgical Techniques ◽

Peripheral Nerve Repair

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Peripheral Nerve Reconstruction after Injury: A Review of Clinical and Experimental Therapies

BioMed Research International ◽

10.1155/2014/698256 ◽

2014 ◽

Vol 2014 ◽

pp. 1-13 ◽

Cited By ~ 315

Author(s):

D. Grinsell ◽

C. P. Keating

Keyword(s):

Peripheral Nerve ◽

Nerve Repair ◽

Peripheral Nerve Regeneration ◽

Surgical Techniques ◽

The Body ◽

Sensory Function ◽

Nerve Reconstruction ◽

Nerve Transfers ◽

Experimental Therapies ◽

Surgical Options

Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain good to excellent motor or sensory function and current surgical techniques are similar to those described by Sunderland more than 60 years ago. Our increasing knowledge about nerve physiology and regeneration far outweighs our surgical abilities to reconstruct damaged nerves and successfully regenerate motor and sensory function. It is technically possible to reconstruct nerves at the fascicular level but not at the level of individual axons. Recent surgical options including nerve transfers demonstrate promise in improving outcomes for proximal nerve injuries and experimental molecular and bioengineering strategies are being developed to overcome biological roadblocks limiting patient recovery.

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Sensory Recovery Outcome after Digital Nerve Repair in Relation to Different Reconstructive Techniques: Meta-Analysis and Systematic Review

Plastic Surgery International ◽

10.1155/2013/704589 ◽

2013 ◽

Vol 2013 ◽

pp. 1-17 ◽

Cited By ~ 23

Author(s):

Felix J. Paprottka ◽

Petra Wolf ◽

Yves Harder ◽

Yasmin Kern ◽

Philipp M. Paprottka ◽

...

Keyword(s):

Meta Analysis ◽

Nerve Repair ◽

Donor Site ◽

Surgical Techniques ◽

Graft Material ◽

Digital Nerve ◽

Nerve Reconstruction ◽

Level Of Evidence ◽

Sensory Recovery ◽

End To End

Good clinical outcome after digital nerve repair is highly relevant for proper hand function and has a significant socioeconomic impact. However, level of evidence for competing surgical techniques is low. The aim is to summarize and compare the outcomes of digital nerve repair with different methods (end-to-end and end-to-side coaptations, nerve grafts, artificial conduit-, vein-, muscle, and muscle-in-vein reconstructions, and replantations) to provide an aid for choosing an individual technique of nerve reconstruction and to create reference values of standard repair for nonrandomized clinical studies. 87 publications including 2,997 nerve repairs were suitable for a precise evaluation. For digital nerve repairs there was practically no particular technique superior to another. Only end-to-side coaptation had an inferior two-point discrimination in comparison to end-to-end coaptation or nerve grafting. Furthermore, this meta-analysis showed that youth was associated with an improved sensory recovery outcome in patients who underwent digital replantation. For end-to-end coaptations, recent publications had significantly better sensory recovery outcomes than older ones. Given minor differences in outcome, the main criteria in choosing an adequate surgical technique should be gap length and donor site morbidity caused by graft material harvesting. Our clinical experience was used to provide a decision tree for digital nerve repair.

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A new method of nerve repair: Repair of a lesion of the radial nerve with a branch to the triceps muscle

British Journal of Surgery ◽

10.1002/bjs.1800650519 ◽

1978 ◽

Vol 65 (5) ◽

pp. 352-353 ◽

Cited By ~ 3

Author(s):

R. V. Gore

Keyword(s):

Radial Nerve ◽

Nerve Repair ◽

New Method ◽

Triceps Muscle

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Facial Reanimation after Facial Nerve Injury

Neurosurgery ◽

10.1227/00006123-199110000-00014 ◽

1991 ◽

Vol 29 (4) ◽

pp. 568-574 ◽

Cited By ~ 28

Author(s):

Robert H. Rosenwasser ◽

Emil Liebman ◽

Fernando D. Jimenez ◽

William A. Buchheit ◽

David W. Andrews

Keyword(s):

Facial Nerve ◽

Nerve Repair ◽

Surgical Techniques ◽

Nerve Transfers ◽

Muscle Transfers ◽

Facial Reanimation ◽

Nerve Anastomosis ◽

Difficult Challenge ◽

And Function ◽

Regional Muscle

Abstract Patients with facial paralysis are often seen in neurosurgical practice. Obtaining full facial symmetry and function after facial nerve damage presents the neurosurgeon with a difficult challenge. Various surgical techniques have been developed to deal with this problem. These include primary nerve repair, nerve to nerve anastomosis, nerve grafting, neurovascular pedicle grafts, regional muscle transposition, microvascular muscle transfers, and nerve transfers. Patient selection, timing of surgery, and details of surgical technique are discussed. The results of hvpoglossal-facial anastomosis in 24 patients are described.

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Transfer of Sensory Branches of Radial Nerve in Hand Surgery

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(93)90079-u ◽

1993 ◽

Vol 18 (3) ◽

pp. 409-409

Author(s):

R. Matloubi

Keyword(s):

Radial Nerve ◽

Surgical Techniques ◽

Hand Surgery ◽

War Injuries ◽

Irreparable Damage

Transfer of sensory branches of the radial nerve to sensory branches of the ulnar or median nerves has been carried out to restore sensitivity to the digits in patients suffering from severe, longstanding and irreparable damage to the median or ulnar nerves, due to war injuries. The author describes the two surgical techniques in detail and reports the results obtained.

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Surgical Treatment of Radial Nerve Injuries Associated With Humeral Shaft Fracture—A Single Center Experience

Frontiers in Surgery ◽

10.3389/fsurg.2021.774411 ◽

2021 ◽

Vol 8 ◽

Author(s):

Lukas Rasulić ◽

Slavko Djurašković ◽

Novak Lakićević ◽

Milan Lepić ◽

Andrija Savić ◽

...

Keyword(s):

Radial Nerve ◽

Nerve Repair ◽

Expectant Management ◽

Shaft Fracture ◽

Humeral Shaft Fracture ◽

Humeral Shaft ◽

Functional Improvement ◽

Surgical Approaches ◽

Nerve Injuries ◽

Strength Assessment

Radial nerve injuries are often associated with humeral shaft fractures. The results of treatment of these injuries, by contemporary surgical approaches, remain diverse. In this paper we presented the outcomes and analyzed the patient, clinical, and surgical procedure related characteristics and factors that may influence the outcome overall, in 77 patients treated at Clinic for Neurosurgery, Clinical Center of Serbia during a 20 years period. The nerve injuries were verified by US and EMNG. The majority of patients were treated by neurolysis or sural nerve grafting, while only few were treated by direct suture. The final recovery was evaluated by muscle strength assessment and classified using MRC. We analyzed extension of the wrist, extension of the fingers including the thumb, and abduction of the thumb. There was a significant statistical difference in MRC grade following the treatment. The total rate of useful functional recovery was achieved in 69 (89.61%) out of all studied patients, out of whom 20 (28.99%) achieved excellent recovery, 26 (37.68%) achieved good recovery and 23 (33.33%) achieved fair recovery. Only 8 (10.39%) out of all studied patients achieved poor recovery. The injured nerves, that were preserved in continuity, acquired by a low-energy trauma, and treated earlier than the 6 months were associated with better functional outcome following the surgery. In addition, there was a trend of better functional improvement with aging, keeping in mind that the old were subjected to lower energy trauma. The expectant management followed by surgery of radial nerve injury associated with humeral shaft fracture should be around 3 months, and the surgical nerve repair should not be performed later than the 6 months after injury. The energy of trauma may be a factor predicting patient's final recovery following the treatment.

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Topographical, anatomical and neurosurgical aspects of "end-to-side" nerve repair

Vestnik of Russian military medical Academy ◽

10.17816/brmma63628 ◽

2021 ◽

Vol 23 (1) ◽

pp. 121-128

Author(s):

A. Y. Nisht ◽

Nikolay F. Fomin ◽

Vladimir P. Orlov

Keyword(s):

Median Nerve ◽

Ulnar Nerve ◽

Lateral Surface ◽

Peripheral Nerves ◽

Radial Nerve ◽

Surgical Techniques ◽

Nerve Fibers ◽

Individual Variability ◽

Motor Branch ◽

Deep Branch

The article presents the results of a comprehensive anatomical and experimental study of individual variability in the structure and topography of motor branches of peripheral nerves in relation to the justification of methods for selective reinnervation of tissues by the "end-to-side" neurorrhaphy. It was found that relatively longer branches of peripheral nerves with a small number of connecting inter-arm collaterals characteristic of narrow and long limbs create conditions for less traumatic mobilization of motor branches. In cases with relatively wide and short extremities mobilization of peripheral nerves is complicated by the presence of a large number of collateral branches and intra-trunk connections, which are often damaged when separate bundles that make up the mobilized branches of the donor or recipient nerve are isolated from the main nerve trunk. It has been shown that potential recipient nerves should be motor branches of peripheral nerves, the preservation of which is of fundamental importance for the function of the corresponding segment of the limb. To create conditions conducive to selective reinnervation of functionally significant muscle groups of the upper limb, we have developed, justified from anatomical positions, and tested in an experiment on anatomical material methods for connecting the distal motor branches of peripheral nerves by the "end-to-side" neurorrhaphy. The main idea of accelerated recovery of the thumb opposition in injuries of the median nerve is to reinnervate the muscles of the elevation of the I finger due to nerve fibers that are part of the deep branch of the ulnar nerve. For this purpose, surgical techniques have been developed for connecting the recurrent motor branch of the damaged median nerve mobilized at the level of the wrist with the edges of a surgically formed perineurium defect on the lateral surface of the bundles that make up the deep branch of the ulnar nerve. In another clinical situation, in patients with radial nerve injuries, for the muscle reinnervation, а method is proposed for neurotisation of the deep motor branch of the radial nerve by the end-to-side suture to the lateral surface of the median nerve. We assume that performing the "end-to-side" nerve suture at the level of the base of the hand in the cases of proximal damage to the median nerve will reduce the time of reinnervation of the muscles of the thumb elevation by 400450 days. Transposition of the deep branch of the damaged at the proximal level radial nerve with "end-to-side" neurorrhaphy to the median nerve by 250300 days (based on the total length of the shoulder and forearm, which is about 50 cm and the rate of regeneration of nerve fibers 1 mm per day). Accordingly, with higher injuries (brachial plexus), the gain in the time of reinnervation of the distal segments will be even greater. In our opinion, the results can be used as a basis for further clinical research on the development of methods for selective tissue reinnervation in cases with isolated injuries of the peripheral nerves.

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