The Reversed Venous Arterialized Nerve Graft in Digital Nerve Reconstruction Across Scarred Beds

Abstract BACKGROUND Traumatic brachial plexus injuries cause long-term maiming of patients. The major target function to restore in complex brachial plexus injury is elbow flexion. OBJECTIVE To retrospectively analyze the correlation between the length of the nerve graft and the strength of target muscle recovery in extraplexual and intraplexual nerve transfers. METHODS A total of 51 patients with complete or near-complete brachial plexus injuries were treated with a combination of nerve reconstruction strategies. The phrenic nerve (PN) was used as axon donor in 40 patients and the spinal accessory nerve was used in 11 patients. The recipient nerves were the anterior division of the upper trunk (AD), the musculocutaneous nerve (MC), or the biceps branches of the MC (BBs). An index comparing the strength of elbow flexion between the affected and the healthy arms was correlated with the choice of target nerve recipient and the length of nerve grafts, among other parameters. The mean follow-up was 4 yr. RESULTS Neither the choice of MC or BB as a recipient nor the length of the nerve graft showed a strong correlation with the strength of elbow flexion. The choice of very proximal recipient nerve (AD) led to axonal misrouting in 25% of the patients in whom no graft was employed. CONCLUSION The length of the nerve graft is not a negative factor for obtaining good muscle recovery for elbow flexion when using PN or spinal accessory nerve as axon donors in traumatic brachial plexus injuries.

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Reconstruction of Proper Digital Nerve Defects in the Thumb Using a Pedicle Nerve Graft

Plastic & Reconstructive Surgery ◽

10.1097/prs.0b013e318267d56b ◽

2012 ◽

Vol 130 (5) ◽

pp. 1089-1097 ◽

Cited By ~ 10

Author(s):

Chao Chen ◽

Peifu Tang ◽

Xu Zhang

Keyword(s):

Nerve Graft ◽

Digital Nerve

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Vastus lateralis vascularized nerve graft in facial nerve reconstruction: An anatomical cadaveric study and clinical implications

Microsurgery ◽

10.1002/micr.22311 ◽

2014 ◽

Vol 35 (2) ◽

pp. 135-139 ◽

Cited By ~ 9

Author(s):

Nikolaos Agrogiannis ◽

Shai Rozen ◽

Gangadasu Reddy ◽

Thorir Audolfsson ◽

Andres Rodriguez-Lorenzo

Keyword(s):

Facial Nerve ◽

Vastus Lateralis ◽

Nerve Graft ◽

Cadaveric Study ◽

Clinical Implications ◽

Nerve Reconstruction ◽

Facial Nerve Reconstruction

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Termino-lateral nerve suture in lesions of the digital nerves: clinical experience and literature review

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193409337959 ◽

2009 ◽

Vol 35 (2) ◽

pp. 109-114 ◽

Cited By ~ 16

Author(s):

S. Artiaco ◽

P. Tos ◽

L. G. Conforti ◽

S. Geuna ◽

B. Battiston

Keyword(s):

Clinical Experience ◽

Functional Results ◽

Discrimination Test ◽

Digital Nerve ◽

Nerve Reconstruction ◽

Nerve Lesions ◽

Nerve Suture ◽

Sensory Recovery ◽

The Mean ◽

The One

Documented experience of treatment of digital nerve lesions with the termino-lateral (end-to-side) nerve suture is limited. Our clinical experience of this technique is detailed here alongside a systematic review of the previous literature. We performed, from 2002 to 2008, seven termino-lateral sutures with epineural window opening for digital nerve lesions. Functional outcome was analysed using the two-point discrimination test and the Semmes–Weinstein monofilament test. The results showed a sensory recovery of S3+ in six cases and S3 in one case. The mean distance found in the two-point discrimination test was 12.7 mm (range 8–18 mm). After a review of the literature, we were able to obtain homogeneous data from 17 additional patients operated by termino-lateral coaptation. The overall number of cases included in our review was 24. A sensory recovery was observed in 23 out of 24 patients. The functional results were S0 in one case, S3 in one case, S3+ in twenty cases and S4 in two cases. Excluding the one unfavourable case, the mean distance in the two-point discrimination test was 9.7 mm (range 3–18 mm). It can thus be concluded that the treatment of digital nerve lesions with termino-lateral suture showed encouraging results. Based on the results obtained in this current study we believe that in case of loss of substance, end-to-side nerve coaptation may be an alternative to biological and synthetic tubulisation when a digital nerve reconstruction by means of nerve autograft is declined by the patient.

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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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Application of Autogenous Venous Nerve Conduits for Digital Nerve Reconstruction

Atlas of the Hand Clinics ◽

10.1016/j.ahc.2004.11.001 ◽

2005 ◽

Vol 10 (1) ◽

pp. 135-140 ◽

Cited By ~ 1

Author(s):

D CHIU ◽

J SAVUNDRA

Keyword(s):

Digital Nerve ◽

Nerve Reconstruction ◽

Nerve Conduits

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Microsurgical Management of Hypoglossal Schwannomas Over 3 Decades: A Modified Grading Scale to Guide Surgical Approach

Operative Neurosurgery ◽

10.1227/neu.0b013e318223b637 ◽

2011 ◽

Vol 69 (suppl_2) ◽

pp. ons121-ons140 ◽

Cited By ~ 9

Author(s):

Yoichi Nonaka ◽

Peter M. Grossi ◽

Ketan R. Bulsara ◽

Raymond M. Taniguchi ◽

Allan H. Friedman ◽

...

Keyword(s):

Sural Nerve ◽

Hypoglossal Nerve ◽

Type A ◽

Nerve Graft ◽

Type B ◽

Nerve Reconstruction ◽

Type D ◽

Grading Scale ◽

Type C ◽

Sural Nerve Graft

Abstract BACKGROUND Schwannomas originating from the hypoglossal nerve are extremely rare. Microsurgical resection with the goal for cure has traditionally been associated with a high risk of postoperative deficits. OBJECTIVE To summarize our clinical experience using tailored cranial base approaches for these formidable lesions. METHODS The clinical records of 13 patients were retrospectively reviewed. In addition, all reported patients in the literature were reviewed. The extreme lateral infrajugular transcondylar-transtubercular exposure approach was used in all of our patients. Based on our experience and literature analysis, we propose the following modified grading scale to facilitate surgical planning: type A, intradural tumors; type B, dumbbell-shaped tumors; type C, extracranial tumors; and type D, peripheral tumors. RESULTS All 13 patients underwent total, near-total, or subtotal tumor resection. Eight patients were men, 5 were women (mean age, 41.7 years). Sural nerve graft reconstruction for the hypoglossal nerve was performed in 4 patients. Three of the 4 patients in whom nerve reconstruction was performed regained satisfactory movement of their tongue. In the review of the literature, the mean patient age was 45.8 years. Patients presented with tongue atrophy (91.6%), headache (60.9%), and dysphagia (31.8%). The tumors were categorized as type A in 31.7% of these patients, type B in 38.6%, type C in 6.2%, and type D in 23.4%. CONCLUSION The extreme lateral infrajugular transcondylar-transtubercular exposure approach, which is a modification of the extreme lateral suboccipital approach, provides sufficient exposure for most intracranial dumbbell-shaped hypoglossal schwannomas. Hypoglossal nerve reconstruction using a sural nerve graft improves tongue atrophy and movement for patients with resected nerves.

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