scholarly journals Distal Digital Nerve Repair Using Nerve Allograft With a Dermal Substitute: A Case Report

Hand ◽  
2019 ◽  
Vol 15 (4) ◽  
pp. NP47-NP50
Author(s):  
Desirae McKee ◽  
Bradley Osemwengie ◽  
Cameron Cox
Keyword(s):  
Nerve Repair ◽  
Skin Substitute ◽  
Soft Tissue Coverage ◽  
Dermal Substitute ◽  
Digital Nerve ◽  
Viable Option ◽  
The Past ◽  
Nerve Conduits ◽  
Small Nerve

Background: Distal digital nerve repairs can present unique challenges for hand surgeons due to their sensitive location and ongoing difficulty obtaining soft tissue coverage in this region. Although autografts and nerve conduits have been shown to be of benefit with nerve gaps, they can have morbidities associated with their use. Nerve allografts have become a viable option over the past decade as their use has increased and data are now showing similar outcomes, particularly in short gap segments. Flaps and skin grafts are traditional coverage options for full thickness wounds but can pose challenges with multiple digit involvement, depth of wound, and critical structures exposed. Methods: We present a case where nerve allograft was used for distal digital nerve repair. Due to the distal nature of the nerve repair in the index digit distal to the trifurcation, the distal end of the nerve graft was connected to multiple small nerve ends. Dermal substitute was placed to achieve distal coverage of the affected digits. Results: At 6-month follow-up, the patient demonstrated improved strength, normal sensation, and full return of digital function. Conclusion: Nerve allograft can be used in combination with dermal skin substitute to achieve normal sensation and return of digital function following distal digital nerve injuries.

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 Missile Injury of the Sciatic Nerve: Observational Study Supporting Early Exploration and Direct Suture With Flexed Knee

2019 ◽  
Vol 184 (11-12) ◽  
pp. e937-e944 ◽  
Author(s):  
Laurent Mathieu ◽  
Georges Pfister ◽  
James Charles Murison ◽  
Christophe Oberlin ◽  
Zoubir Belkheyar
Keyword(s):  
Sciatic Nerve ◽  
Nerve Repair ◽  
Soft Tissue Coverage ◽  
Proximal Lesion ◽  
Missile Injury ◽  
Key Points ◽  
Early Exploration ◽  
Gastrocnemius Muscles ◽  
Violent Conflicts

Abstract Missile injuries of the sciatic nerve are frequently encountered in modern violent conflicts. Gunshot and fragment wounds may cause large nerve defects, for which management is challenging. The great size of the sciatic nerve, in both diameter and length, explains the poor results of nerve repair using autografts or allografts. To address this issue, we used a simple technique consisting of a direct suture of the sciatic nerve combined with knee flexion for 6 weeks. Despite a published series showing that this procedure gives better results than sciatic nerve grafting, it remains unknown or underutilized. The purpose of this cases study is to highlight the efficiency of direct sciatic nerve coaptation with knee flexed through three cases with missile injuries at various levels. At the follow-up of two years, all patients were pain free with a protective sensory in the sole and M3+ or M4 gastrocnemius muscles, regardless of the injury level. Recovery was also satisfying in the fibular portion, except for the very proximal lesion. No significant knee stiffness was noticed, including in a case suffering from an associated distal femur fracture. Key points to enhance functional recovery are early nerve repair (as soon as definitive bone fixation and stable soft-tissue coverage are achieved) and careful patient selection.

scholarly journals Long-Term Outcomes of Digital Nerve Repair Accompanied by Digital Artery Injury in Flexor Zone 2

2019 ◽  
Vol 06 (01) ◽  
pp. e7-e9
Author(s):  
Gokce Yildiran ◽  
Mustafa Sutcu ◽  
Osman Akdag ◽  
Zekeriya Tosun
Keyword(s):  
Blood Flow ◽  
Blood Supply ◽  
Nerve Repair ◽  
Arterial Injury ◽  
Digital Artery ◽  
Digital Nerve ◽  
Significant Difference ◽  
Sensory Recovery

Abstract Objectives Better healing results of any tissue or area is closely linked with a well-blood supply in reconstructive surgery. Peripheric nerve healing is closely related to blood supply as well. We aimed to assess whether there was any difference between digital nerve healing with and without extrinsic blood supply. Methods We assessed 48 patients with unilateral digital nerve injury at zone 2. Twenty-four of them had unrepairable arterial injury and other 24 had no arterial injury. The 24 patients in the “unrepaired artery group” (UA) and 24 patients in the “intact artery group” (IA) were compared. Results Mean follow-up time was 17.7 months. The mean two-point discrimination (2PD) was 5.29 mm in IA group and 5.37 mm in UA group. One neuroma in IA group and two neuromas in UA group were determined. We found no statistically significant difference between these groups in terms of neuroma, 2PD, and cold intolerance. The results of British Medical Research Council sensory recovery clinical scale were comparable for these two groups. Conclusion Digital nerve healing is related to numerous factors. We hypothesized that blood flow may be one of these factors; however, at this zone digital artery repair is not the foremost determinant for digital nerve healing. Further researches should be done for upper injury levels. Despite this result, we argue not to leave the digital artery without repairment and we propose to repair both artery and nerve to achieve the normal anatomical integrity and to warrant finger blood flow in possible future injuries.

Age does not affect the outcome after digital nerve repair in children – A retrospective long term follow up

2017 ◽  
Vol 22 (5) ◽  
pp. 915-918 ◽  
Author(s):  
Hans-Eric Rosberg ◽  
Derya Burcu Hazer Rosberg ◽  
Illugi Birkisson ◽  
Lars B. Dahlin
Keyword(s):  
Nerve Repair ◽  
Digital Nerve ◽  
Long Term Follow Up

Does nerve repair influence the outcome of reconstruction of a digital nail defect using a free composite flap taken from the great toe?

2014 ◽  
Vol 40 (6) ◽  
pp. 583-590 ◽  
Author(s):  
X. Zhang ◽  
C. Chen ◽  
Y. Li ◽  
X. Shao ◽  
W. Guo ◽  
...  
Keyword(s):  
Nerve Repair ◽  
Donor Site ◽  
Digital Nerve ◽  
Great Toe ◽  
Dorsal Branch ◽  
Mean Size ◽  
The Mean ◽  
Repair Group ◽  
Composite Flap

We describe reconstruction of a nail unit defect in the finger using a free composite flap taken from the great toe, comparing the outcome in patients in whom neurorrhaphy between the dorsal digital nerve of the great toe and the dorsal branch of the proper digital nerve of the injured finger was performed to those in which no nerve repair was made. From January 2002 to March 2009, 47 patients with traumatic fingernail defects were treated. Twenty-two patients before February 2005 had no nerve repair and subsequently 25 patients had nerve repair. The mean size of the germinal matrix and sterile matrix defects was 9 × 8 mm, and the mean size of the nail bed flaps was 9 × 9 mm. The mean length of the arteries used for the flap was 2.2 cm. Outcomes were rated. In the nerve repair group, full flap survival was achieved in 24 patients. At the mean follow-up period of 25 months, there were 12 excellent, seven very good, four good, and two fair results. In the comparison group without nerve repair, there were seven excellent, four very good, four good, five fair, and two poor results. Donor site morbidities were similar in both groups. The use of a free composite flap taken from the great toe is a useful technique for reconstructing nail unit defects in the finger. Innervated nail flap reconstructions tended to show better outcomes than those in which no nerve repair was performed. There is no difference in function or donor site between those in whom the nerve was repaired compared with those in whom it was not repaired.

Replantation

2019 ◽  
pp. 955-962
Author(s):  
Grant M. Kleiber ◽  
Keith E. Brandt
Keyword(s):  
Nerve Repair ◽  
Tendon Repair ◽  
Postoperative Management ◽  
Team Approach ◽  
Soft Tissue Coverage ◽  
Transport Services ◽  
Emergency Transport ◽  
Multiple Variables ◽  
Bony Fixation

Successful replantation depends on multiple variables. A coordinated effort of emergency transport services, emergency room personnel, operating room staff, anesthesiologists and postoperative nursing is required for success. The need for this team approach has led to the development of several specialized replantation centers worldwide. The authors discuss the various mechanisms of injury and their chances for successful replantation. This chapter examines the indications and contraindications for appropriate replantation. Also provided are many useful techniques for vessel and nerve repair, bony fixation, tendon repair, and soft tissue coverage. The chapter also discusses postoperative management, rehabilitation, and follow-up.

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