FLEXOR TENDON AND PERIPHERAL NERVE REPAIR

Hand Surgery ◽  
2002 ◽  
Vol 07 (01) ◽  
pp. 83-100 ◽  
Author(s):  
Judith A. Bell Krotoski
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Flexor Tendon ◽  
Nerve Repair ◽  
Hand Function ◽  
Tendon Injury ◽  
Finger Movement ◽  
Flexor Tendon Injury ◽  
Direct Injury

Any restoration of hand function following tendon and nerve injury has to include the repair or replacement of the hand's ability to perform a great many tasks. It is hard at first to appreciate fully the loss that occurs with flexor tendon injury. With loss of flexor tendons operating at the fingers or thumb, they cannot be fully closed and the hand is impaired for grasp and release as it interfaces with objects. But, sensibility can also be compromised from tendon injury even without direct injury to nerve, as object recognition in the absence of vision requires finger movement. When peripheral nerve injury is combined with flexor tendon injury, sensibility is directly impaired. There is a loss in the sense of finger or thumb position, pain, temperature, and touch/pressure recognition, in addition to the tendon injury.

scholarly journals A study on graphene composites for peripheral nerve injury repair under electrical stimulation

RSC Advances ◽  
2019 ◽  
Vol 9 (49) ◽  
pp. 28627-28635 ◽  
Author(s):  
Zhiqiang Huang ◽  
Zhenzhao Guo ◽  
Manman Sun ◽  
Shaomao Fang ◽  
Hong Li
Keyword(s):  
Electrical Stimulation ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Nerve Repair ◽  
Effective Alternative ◽  
Peripheral Nerve Repair ◽  
Injury Repair

Electrical stimulation (ES) provides an effective alternative to peripheral nerve repair via conductive scaffolds.

scholarly journals Surgical outcome of prognostic factors for final outcome of hand function following primary median nerve repair

2018 ◽  
Vol 5 (11) ◽  
pp. 3672
Author(s):  
S. Dhanaraju ◽  
N. Kannan
Keyword(s):  
Prognostic Factors ◽  
Median Nerve ◽  
Nerve Injury ◽  
Functional Recovery ◽  
Nerve Repair ◽  
Hand Function ◽  
Tendon Injury ◽  
Final Outcome ◽  
Nerve Injuries ◽  
Median Nerve Injury

Background: A major problem in surgery of median nerve injuries is the unpredictable final outcome, so identifying the prognostic factors for final outcome is needed in primary median nerve repair following injury. Assessing the functional recovery of hand function following median nerve repair.Methods: Total no. of patients with median nerve injury repaired in our institution was 70. All the patients assessed preoperatively by clinical examination, surgery performed immediately or within 12 hours of injury, performed under axillary block and tourniquet control, Multiple surgeons involved (about 6 surgeons). All are primarily repaired nerves, repair by 70 prolene epineural sutures, postoperative immobilization of 3 weeks.Results: Median nerve injury associated with other flexors involved patients show good functional recovery, the functional recovery deteriorate once involvement of finger flexors, particularly if all the tendons were injured. The arterial injury and repair don’t seem to influence the outcome of the hand function, but both artery involvement usually associated with all tendon injury, it shows poor outcome.Conclusions: The more distal the injury the outcome will be quicker as compared to middle 1/3 and proximal 1/3 injuries. Pure median nerve injuries sensory recovery in S4 grade about 5%, S3+ recovery of sensation is about 36%. Pure median nerve injury patients M4 motor recovery about 54%.Only median nerve injury the final outcome is good but combined median and ulnar nerve injury and associated tendon injury the outcome is poor. 

scholarly journals Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon

2021 ◽  
Vol 6 (8) ◽  
pp. 607-617
Author(s):  
Timothy Bage ◽  
Dominic M. Power
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Trauma Surgery ◽  
Limb Lengthening ◽  
Nerve Blocks ◽  
True Incidence ◽  
Direct Injury ◽  
Arthroplasty Surgery

Nerves may be inadvertently injured during trauma surgery due to distorted anatomy, traction applied to a limb, soft tissue retraction, by power tools, instrumentation and from compartment syndrome. Elective orthopaedic surgery has additional risks of joint dislocation for arthroplasty surgery, limb lengthening, thermal injury from cement and direct injury from peripheral nerve blocks. The true incidence is unknown, and many cases are diagnosed as neurapraxia with the expectation of a full and timely recovery without the need for intervention. The incorrect assignation of a neurapraxia diagnosis may delay treatment for a higher grade of injury and in addition fails to recognize that a diagnosis of neurapraxia should be made with caution and a commitment to regular clinical review. Untreated, a neurapraxia can deteriorate and result in axonopathy. The failure to promptly diagnose such a nerve injury and instigate treatment may result in further deterioration and expose the clinician to medicolegal challenge. The focus of this review is to raise awareness of iatrogenic peripheral nerve injuries in orthopaedic limb surgery, the importance of regular clinical examination, the role of investigations, timing and nature of interventions and also to provide a guide to when onward referral to a specialist peripheral nerve injury unit is recommended. Cite this article: EFORT Open Rev 2021;6:607-617. DOI: 10.1302/2058-5241.6.200123

scholarly journals Debates to personal conclusion in peripheral nerve injury and reconstruction: A 30-year experience at Chang Gung Memorial Hospital

2016 ◽  
Vol 49 (02) ◽  
pp. 144-150 ◽  
Author(s):  
David Chwei-Chin Chuang
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Nerve Repair ◽  
Memorial Hospital ◽  
Chang Gung Memorial Hospital ◽  
The Past ◽  
Nerve Transfers ◽  
Facial Synkinesis

ABSTRACTSignificant progress has been achieved in the science and management of peripheral nerve injuries over the past 40 years. Yet there are many questions and few answers. The author, with 30 years of experience in treating them at the Chang Gung Memorial Hospital, addresses debates on various issues with personal conclusions. These include: (1) Degree of peripheral nerve injury, (2) Timing of nerve repair, (3)Technique of nerve repair, (4) Level of brachial plexus injury,(5) Level of radialnerve injury,(6) Traction avulsion amputation of major limb, (7) Proximal Vs distal nerve transfers in brachial plexus injuries and (8) Post paralysis facial synkinesis.

scholarly journals A Porcine Model of Peripheral Nerve Injury Enabling Ultra-Long Regenerative Distances: Surgical Approach, Recovery Kinetics, and Clinical Relevance

2019 ◽  
Author(s):  
Justin C. Burrell ◽  
Kevin D. Browne ◽  
John L. Dutton ◽  
Suradip Das ◽  
Daniel P. Brown ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Surgical Approach ◽  
Peripheral Nerve Injury ◽  
Peroneal Nerve ◽  
Porcine Model ◽  
Nerve Repair ◽  
Peripheral Nerve Regeneration ◽  
Common Peroneal Nerve ◽  
Nerve Autograft

AbstractApproximately 20 million Americans currently experience residual deficits from traumatic peripheral nerve injury. Despite recent advancements in surgical technique, peripheral nerve repair typically results in poor functional outcomes due to prolonged periods of denervation resulting from long regenerative distances coupled with relatively slow rates of axonal regeneration. Development of novel surgical solutions requires valid preclinical models that adequately replicate the key challenges of clinical peripheral nerve injury. Our team has developed a porcine model using Yucatan minipigs that provides an opportunity to investigate peripheral nerve regeneration using different nerves tailored for a specific mechanism of interest, such as (1) nerve modality: motor, sensory, and mixed-modality; (2) injury length: short versus long gap; and (3) total regenerative distance: proximal versus distal injury. Here, we describe a comprehensive porcine model of two challenging clinically relevant procedures for repair of long segmental lesions (≥ 5 cm) – the deep peroneal nerve repaired using a sural nerve autograft and the common peroneal nerve repaired using a saphenous nerve autograft – each featuring ultra-long total regenerative distances (up to 20 cm and 27 cm, respectively) to reach distal targets. This paper includes a detailed characterization of the relevant anatomy, surgical approach/technique, functional/electrophysiological outcomes, and nerve morphometry for baseline and autograft repaired nerves. These porcine models of major peripheral nerve injury are suitable as preclinical, translatable models for evaluating the efficacy, safety, and tolerability of next-generation artificial nerve grafts prior to clinical deployment.

scholarly journals MicroRNA Mediated Regulation of Schwann Cell Migration and Proliferation in Peripheral Nerve Injury

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Eun Jung Sohn ◽  
Hwan Tae Park
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerves ◽  
Peripheral Nerve Injury ◽  
Nerve Repair ◽  
Noncoding Rnas ◽  
Potential Therapeutic Target ◽  
Neuronal Disease ◽  
Cell Migration And Proliferation ◽  
Nerve System

Schwann cells (SCs) contribute to nerve repair following injury; however, the underlying molecular mechanism is poorly understood. MicroRNAs (miRNAs), which are short noncoding RNAs, have been shown to play a role in neuronal disease. In this work, we show that miRNAs regulate the peripheral nerve system by modulating the migration and proliferation of SCs. Thus, miRNAs expressed in peripheral nerves may provide a potential therapeutic target for peripheral nerve injury or repair.

scholarly journals The Thermal Sensitivity Test in Evaluating Outcome after Peripheral Nerve Injury

2015 ◽  
Vol 2015 ◽  
pp. 1-9
Author(s):  
Marcin Ceynowa ◽  
Tomasz Mazurek ◽  
Rafał Pankowski ◽  
Marek Rocławski ◽  
Mariusz Treder
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Thermal Sensitivity ◽  
Hand Function ◽  
Cold Intolerance ◽  
Measuring Device ◽  
Knowing That ◽  
Functional Scores ◽  
Temperature Sense

The purpose of this study was to evaluate the ability to discriminate temperatures in patients following peripheral nerve injury. Knowing that temperature sensibility is mediated by different receptors, the scores were compared to other functional hand scores in order to determine whether the ability to discriminate temperatures is restored to a different extent compared with other commonly evaluated hand function modalities. The test was performed using the NTE-2 device (Physitemp Instruments Inc., 154 Huron Avenue, Clifton, New Jersey, USA). Out of 57 patients, 27 had normal thermal discrimination scores, and 9 could not tell the temperatures apart in the differences set on the measuring device. Overall, patients with better thermal discrimination had also better hand function as evaluated with different methods. However, some patients who did regain the ability to differentiate temperatures correctly did not have any measurable return of hand function in other tests. Thermal discrimination scores correlated similarly with different functional scores, except for vibration sensibility, which did not show any significant correlation. The development and severity of cold intolerance seem to be unrelated to temperature sense.

scholarly journals Underlying histopathology of peripheral nerve injury and the classical nerve repair techniques

2019 ◽  
pp. 17-22
Author(s):  
Marin Andrei ◽  
Mihai Ruxandra Ioana ◽  
Enescu Dan Mircea
Keyword(s):  
Nervous System ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Nerve Repair ◽  
Experimental Studies ◽  
Key Factors ◽  
Regeneration Rate ◽  
The Central Nervous System

A much-debated subject in the last 20 years, the recovery after peripheral nerve injury still remains one of the most researched themes of our days. Although the central nervous system has not exhibited any ground-breaking discoveries in matters of healing through surgical procedures, this is not the case for the peripheral nervous system (PNS). The PNS recovery after injury has improved over the years so we now speak of time and percentage of rehabilitation. The increased interest for this subject is a result in the development of the medical technique, that allowed the creation of new molecules capable to improve the regeneration rate. Furthermore, the evolution in diagnostic parameters, as well as the possibility of a thorough follow-up, contributed to the ascending research of this field.  One must not forget that all experimental studies have as endpoint obtaining safe and reproducible solutions which can be applied in treating patients with peripheral nerve injury. We will briefly present the microscopic events that occur following a peripheral nerve injury, the key factors which influence their regeneration as well as the classical techniques used to repair them. However, the most intriguing topic in nerve regeneration is not related to the surgical procedure (considered to be the Gold Standard in whole nerve injury), but rather the helping substances that facilitate a faster and better recovery.

scholarly journals Epidemiology of Flexor Tendon Injuries of the Hand in a Northern Finnish Population

2016 ◽  
Vol 106 (3) ◽  
pp. 278-282 ◽  
Author(s):  
M. Manninen ◽  
T. Karjalainen ◽  
J. Määttä ◽  
T. Flinkkilä
Keyword(s):  
Nerve Injury ◽  
Flexor Tendon ◽  
Adult Population ◽  
Tendon Injury ◽  
Tendon Injuries ◽  
Digital Nerve ◽  
Finnish Population ◽  
Rare Injury ◽  
Flexor Tendon Injury ◽  
Flexor Tendon Injuries

Background: Flexor tendon injuries cause significant morbidity in working-age population. The epidemiology of these injuries in adult population is not well known. The aim of this study was to describe the epidemiology of flexor tendon injuries in a Northern Finnish population. Material and Methods: Data on flexor tendon injuries, from 2004 to 2010, were retrieved from patient records from four hospitals, which offer surgical repair of the flexor tendon injuries in a well-defined area in Northern Finland. The incidence of flexor tendon injury as well as the gender-specific incidence rates was calculated. Mechanism of injury, concomitant nerve injuries, and re-operations were also recorded. Results: The incidence rate of flexor tendon injury was 7.0/100,000 person-years. The incidence was higher in men and inversely related to age. The most common finger to be affected was the fifth digit. In 37% of injuries also digital nerve was affected. The most common finger to have simultaneous digital nerve injury was the thumb. Conclusion: Flexor tendon laceration is a relatively rare injury. It predominantly affects working-aged young males and frequently includes a nerve injury, which requires microsurgical skills from the surgeon performing the repair. This study describes epidemiology of flexor tendon injuries and therefore helps planning the surgical and rehabilitation services needed to address this entity.

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