Management of Acute Lower Extremity Nerve Injuries

Foot & Ankle ◽  
1986 ◽  
Vol 7 (2) ◽  
pp. 82-94 ◽  
Author(s):  
Peter A. Aldea ◽  
William W. Shaw
Keyword(s):  
Early Intervention ◽  
Lower Extremity ◽  
Peripheral Nerve ◽  
Upper Extremity ◽  
Decision Process ◽  
Nerve Repair ◽  
Internal Anatomy ◽  
Nerve Injuries ◽  
Functional Deficits ◽  
Microsurgical Techniques

While repair of acute nerve injuries in the lower extremity has not been as aggressive as in the upper extremity, there should now be more effective early intervention. Newer microsurgical techniques can be used along with increased understanding of peripheral nerve internal anatomy to obtain more satisfactory repair and reconstruction of the injured nerves. The anatomy and vulnerability of the nerves in the leg are reviewed, and the decision process is analyzed in the context of the functional deficits following such injuries. A priority of goals in lower extremity nerve repair should be established to ensure salvage of the foot.

Primary Repair of Upper Extremity Peripheral Nerve Injuries: An NSQIP Analysis From 2010 to 2016

Hand ◽  
2021 ◽  
pp. 155894472110447
Author(s):  
Ryan Brennan ◽  
Jordan Carter ◽  
Gilberto Gonzalez ◽  
Fernando A. Herrera
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Complication Rate ◽  
Primary Repair ◽  
Nerve Repair ◽  
Multiple Injury ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Improvement Program ◽  
Injury Group

Background To identify the rate of 30-day complications after primary repair of upper extremity peripheral nerve injuries, associated diagnoses, and postoperative complication rate. Methods The American College of Surgeons National Surgical Quality Improvement Program database was reviewed from 2010 to 2016. Current Procedural Terminology codes consistent with primary nerve repair of the upper extremity were identified and included in the analysis. Patient demographics, comorbidities, type of procedure (elective/emergent), wound class, operative time, and 30-day complications were recorded. Patients with isolated upper extremity nerve injuries (isolated) were compared with those with peripheral nerve injuries in addition to bone, tendon, or soft tissue injuries (multiple). Results In all, 785 patients were identified as having upper extremity nerve repairs (0.16%). Of them, 64% were men and 36% were women; the average patient age was 40 years. The most common indication for surgery was injury to the digits (54% of cases). Thirty-day adverse events occurred in 3% of all cases. Isolated nerve injury occurred in 43% of patients, whereas 57% had additional injuries. The multiple injury group had a significantly higher complication rate compared with the isolated group (1% vs 4.5%) ( P = .007). Repair of tendon at forearm or wrist was the most common concurrent procedure performed. Conclusions Thirty-day complications among upper extremity peripheral nerve injuries are low, accounting for 3% of cases. Return to the operating room accounted for nearly half of all complications. Patients in the multiple injury group accounted for more than half of these and had a significantly higher complication rate compared with patients with isolated nerve injuries.

Traumatic lower extremity and lumbosacral peripheral nerve injuries in adults: Electrodiagnostic studies and patients symptoms

2017 ◽  
Vol 52 ◽  
pp. 89-92 ◽  
Author(s):  
Arash Babaei-Ghazani ◽  
Bina Eftekharsadat ◽  
Bahram Samadirad ◽  
Vida Mamaghany ◽  
Saeed Abdollahian
Keyword(s):  
Lower Extremity ◽  
Peripheral Nerve ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries

Chronic neuropathic pain after traumatic peripheral nerve injuries in the upper extremity: prevalence, demographic and surgical determinants, impact on health and on pain medication

2019 ◽  
Vol 20 (1) ◽  
pp. 95-108
Author(s):  
Adriana Miclescu ◽  
Antje Straatmann ◽  
Panagiota Gkatziani ◽  
Stephen Butler ◽  
Rolf Karlsten ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Upper Extremity ◽  
Nerve Injury ◽  
Persistent Pain ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Chronic Neuropathic Pain ◽  
Younger Age

AbstractBackground and aimsAside from the long term side effects of a nerve injury in the upper extremity with devastating consequences there is often the problem of chronic neuropathic pain. The studies concerning the prevalence of persistent pain of neuropathic origin after peripheral nerve injuries are sparse. The prevalence and risk factors associated with chronic neuropathic pain after nerve injuries in the upper extremity were assessed.MethodsA standardized data collection template was employed prospectively and retrospectively for all patients with traumatic nerve injuries accepted at the Hand Surgery Department, Uppsala, Sweden between 2010 and 2018. The template included demographic data, pain diagnosis, type of injured nerve, level of injury, date of the lesion and repair, type of procedure, reoperation, time since the procedure, S-LANSS questionnaire (Self report-Leeds Assessment of Neuropathic Symptoms and Signs), RAND-36 (Item short form health survey), QuickDASH (Disability of Shoulder, Arm and Hand) and additional questionnaires concerned medication, pain intensity were sent to 1,051 patients with nerve injuries. Partial proportional odds models were used to investigate the association between persistent pain and potential predictors.ResultsMore than half of the patients undergoing a surgical procedure developed persistent pain. Prevalence of neuropathic pain was 73% of the patients with pain (S-LANSS ≥ 12 or more). Multivariate analysis indicated that injury of a major nerve OR 1.6 (p = 0.013), years from surgery OR 0.91 (p = 0.01), younger age OR 0.7 (p < 0.001), were the main factors for predicting pain after surgery. The type of the nerve injured was the strongest predictor for chronic pain with major nerves associated with more pain (p = 0.019).ConclusionsA high prevalence of chronic pain and neuropathic pain with a negative impact on quality of life and disability were found in patients after traumatic nerve injury. Major nerve injury, younger age and less time from surgery were predictors for chronic pain.

Obstetrical Brachial Plexus Lesions

1991 ◽  
Vol 16 (5) ◽  
pp. 489-491 ◽  
Author(s):  
A. GILBERT ◽  
I. WHITAKER
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Nerve Repair ◽  
Regenerative Capacity ◽  
Microsurgical Techniques ◽  
Brachial Plexus Surgery

The renewal of interest in brachial plexus surgery has been led by the success of microsurgical techniques in other peripheral nerve repairs. The results in adults remain poor, but in obstetrical palsy the regenerative capacity of babies allows for dramatic recovery after nerve repair or reconstruction. Obstetrical brachial plexus injuries represent a unique group with similar aetiology, age and prognosis.

Ultrasonographic evaluation of the iatrogenic peripheral nerve injuries in upper extremity

2010 ◽  
Vol 73 (2) ◽  
pp. 234-240 ◽  
Author(s):  
Nuri Karabay ◽  
Tulgar Toros ◽  
Yalçın Ademoğlu ◽  
Sait Ada
Keyword(s):  
Peripheral Nerve ◽  
Upper Extremity ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries

Sensory recovery after cell therapy in peripheral nerve repair: effects of naïve and skin precursor-derived Schwann cells

2014 ◽  
Vol 121 (2) ◽  
pp. 423-431 ◽  
Author(s):  
Antos Shakhbazau ◽  
Chandan Mohanty ◽  
Ranjan Kumar ◽  
Rajiv Midha
Keyword(s):  
Cell Therapy ◽  
Peripheral Nerve ◽  
Schwann Cells ◽  
Therapeutic Potential ◽  
Thermal Sensation ◽  
Thermal Sensitivity ◽  
Nerve Repair ◽  
Peripheral Nerve Repair ◽  
Sensory Recovery ◽  
Microsurgical Techniques

Object Cell therapy is a promising candidate among biological or technological innovations sought to augment microsurgical techniques in peripheral nerve repair. This report describes long-term functional regenerative effects of cell therapy in the rat injury model with a focus on sensory recovery. Methods Schwann cells were derived from isogenic nerve or skin precursor cells and injected into the transected and immediately repaired sciatic nerve distal to the injury site. Sensory recovery was assessed at weeks 4, 7, and 10. Axonal regeneration was assessed at Week 11. Results By Week 10, thermal sensitivity in cell therapy groups returned to a level indistinguishable from the baseline (p > 0.05). Immunohistochemistry at 11 weeks after injury showed improved regeneration of NF+ and IB4+ axons. Conclusions: The results of this study show that cell therapy significantly improves thermal sensation and the number of regenerated sensory neurons at 11 weeks after injury. These findings contribute to the view of skin-derived stem cells as a reliable source of Schwann cells with therapeutic potential for functional recovery in damaged peripheral nerve.

Evaluating Nerve Repair Outcomes in Upper Extremity Nerve Injuries Utilizing Processed Nerve Allografts, Tube Conduit, and Nerve Autograft

2015 ◽  
Vol 40 (9) ◽  
pp. e5 ◽  
Author(s):  
Gregory M. Buncke ◽  
Brian Rinker ◽  
Wesley P. Thayer ◽  
Jason Ko ◽  
Dmitry Tuder ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Nerve Repair ◽  
Nerve Injuries ◽  
Nerve Autograft

scholarly journals Techniques of Peripheral Nerve Repair

2008 ◽  
Vol 97 (4) ◽  
pp. 310-316 ◽  
Author(s):  
L. B. Dahlin
Keyword(s):  
Peripheral Nerve ◽  
Nerve Repair ◽  
Correct Diagnosis ◽  
Nerve Injuries ◽  
Nerve Roots ◽  
Postoperative Rehabilitation ◽  
Cold Intolerance ◽  
Peripheral Nerve Repair ◽  
Nerve Grafts ◽  
Nerve Transfers

Nerve injuries extend from simple nerve compression lesions to complete nerve injuries and severe lacerations of the nerve trunks. A specific problem is brachial plexus injuries where nerve roots can be ruptured, or even avulsed from the spinal cord, by traction. An early and correct diagnosis of a nerve injury is important. A thorough knowledge of the anatomy of the peripheral nerve trunk as well as of basic neurobiological alterations in neurons and Schwann cells induced by the injury are crucial for the surgeon in making adequate decisions on how to repair and reconstruct nerves. The technique of peripheral nerve repair includes four important steps (preparation of nerve end, approximation, coaptation and maintenance). Nerves are usually repaired primarily with sutures applied in the different tissue components, but various tubes are available. Nerve grafts and nerve transfers are alternatives when the injury induces a nerve defect. Timing of nerve repair is essential. An early repair is preferable since it is advantageous for neurobiological reasons. Postoperative rehabilitation, utilising the patients' own coping strategies, with evaluation of outcome are additional important steps in treatment of peripheral nerve injuries. In the rehabilitation phase adequate handling of pain, allodynia and cold intolerance are emphasised.

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