Long-term clinical outcome after epineural coaptation of digital nerves

This study evaluates the long-term clinical outcome and complication rate after digital nerve repair in adults and aims to identify possible prognostic factors of sensory recovery. End-to-end epineural coaptation was performed under magnification. A total of 93 coapted digital nerves were clinically evaluated with a mean follow-up of 3.5 years (range 1–6 years). The mean two-point discrimination was 10.6 mm (versus 4.4 mm for the contralateral side). Cutaneous pressure threshold tested with Semmes–Weinstein monofilaments showed a mean value of 2.7 (versus 2.2 for the contralateral side). Only 2% of our patients developed painful neuromas. None of our patients recovered normal functional sensibility, however, recovery of protective sensation contributed to a high reported level of satisfaction. No correlation was observed between the sensory outcome and age, smoking, mechanism of injury, lesion to or anastomosis of a digital artery, or time of immobilization. The only identified predictor of the result was the surgeon’s level of experience. This highlights the importance of adequate training and practice in the surgical repair of smaller peripheral nerves. Level of evidence: IV

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The effect of early relearning on sensory recovery 4 to 9 years after nerve repair: a report of a randomized controlled study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193418767024 ◽

2018 ◽

Vol 43 (6) ◽

pp. 626-630 ◽

Cited By ~ 2

Author(s):

Pernilla Vikström ◽

Birgitta Rosén ◽

Ingela K Carlsson ◽

Anders Björkman

Keyword(s):

Ulnar Nerve ◽

Motor Skills ◽

Nerve Repair ◽

Controlled Study ◽

Fine Motor ◽

Level Of Evidence ◽

Single Item ◽

Randomized Controlled ◽

Sensory Recovery

Twenty patients randomized to early sensory relearning (nine patients) or traditional relearning (11 patients) were assessed regarding sensory recovery 4 to 9 years after median or ulnar nerve repair. Outcomes were assessed with the Rosen score, questionnaires, and self-reported single-item questions regarding function and activity. The patients with early sensory relearning had significantly better sensory recovery in the sensory domain of the Rosen score, specifically, discriminative touch or tactile gnosis and dexterity. They had significantly less self-reported problems in gripping, clumsiness, and fine motor skills. No differences were found in questionnaires between the two groups. We conclude that early sensory relearning improves long-term sensory recovery following nerve repair. Level of evidence: I

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Clinical Outcomes, Structure, and Function Improve With Both Heavy and Moderate Loads in the Treatment of Patellar Tendinopathy: A Randomized Clinical Trial

The American Journal of Sports Medicine ◽

10.1177/0363546520988741 ◽

2021 ◽

Vol 49 (4) ◽

pp. 982-993

Author(s):

Anne-Sofie Agergaard ◽

Rene B. Svensson ◽

Nikolaj M. Malmgaard-Clausen ◽

Christian Couppé ◽

Mikkel H. Hjortshoej ◽

...

Keyword(s):

Clinical Trial ◽

Clinical Outcome ◽

Randomized Clinical Trial ◽

Clinical Outcomes ◽

Rating Scale ◽

Power Doppler ◽

Patellar Tendinopathy ◽

Short Term ◽

Level Of Evidence

Background: Loading interventions have become a predominant treatment strategy for tendinopathy, and positive clinical outcomes and tendon tissue responses may depend on the exercise dose and load magnitude. Purpose/Hypothesis: The purpose was to investigate if the load magnitude influenced the effect of a 12-week loading intervention for patellar tendinopathy in the short term (12 weeks) and long term (52 weeks). We hypothesized that a greater load magnitude of 90% of 1 repetition maximum (RM) would yield a more positive clinical outcome, tendon structure, and tendon function compared with a lower load magnitude of 55% of 1 RM when the total exercise volume was kept equal in both groups. Study Design: Randomized clinical trial; Level of evidence, 1. Methods: A total of 44 adult participants with chronic patellar tendinopathy were included and randomized to undergo moderate slow resistance (MSR group; 55% of 1 RM) or heavy slow resistance (HSR group; 90% of 1 RM). Function and symptoms (Victorian Institute of Sport Assessment–Patella questionnaire [VISA-P]), tendon pain during activity (numeric rating scale [NRS]), and ultrasound findings (tendon vascularization and swelling) were assessed before the intervention, at 6 and 12 weeks during the intervention, and at 52 weeks from baseline. Tendon function (functional tests) and tendon structure (ultrasound and magnetic resonance imaging) were investigated before and after the intervention period. Results: The HSR and MSR interventions both yielded significant clinical improvements in the VISA-P score (mean ± SEM) (HSR: 0 weeks, 58.8 ± 4.3; 12 weeks, 70.5 ± 4.4; 52 weeks, 79.7 ± 4.6) (MSR: 0 weeks, 59.9 ± 2.5; 12 weeks, 72.5 ± 2.9; 52 weeks, 82.6 ± 2.5), NRS score for running, NRS score for squats, NRS score for preferred sport, single-leg decline squat, and patient satisfaction after 12 weeks, and these were maintained after 52 weeks. HSR loading was not superior to MSR loading for any of the measured clinical outcomes. Similarly, there were no differences in functional (strength and jumping ability) or structural (tendon thickness, power Doppler area, and cross-sectional area) improvements between the groups undergoing HSR and MSR loading. Conclusion: There was no superior effect of exercising with a high load magnitude (HSR) compared with a moderate load magnitude (MSR) for the clinical outcome, tendon structure, or tendon function in the treatment of patellar tendinopathy in the short term. Both HSR and MSR showed equally good, continued improvements in outcomes in the long term but did not reach normal values for healthy tendons. Registration: NCT03096067 (ClinicalTrials.gov identifier)

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

The Surgery Journal ◽

10.1055/s-0039-3400229 ◽

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.

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Extended ray resection for sarcoma of the hand: long-term survival and functional results

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419885039 ◽

2019 ◽

Vol 45 (2) ◽

pp. 160-166 ◽

Cited By ~ 1

Author(s):

Farhad Farzaliyev ◽

Hans-Ulrich Steinau ◽

Halil-Ibrahim Karadag ◽

Alexander Touma ◽

Lars Erik Podleska

Keyword(s):

Soft Tissue ◽

Survival Rates ◽

Soft Tissue Sarcomas ◽

Functional Results ◽

Contralateral Side ◽

Level Of Evidence ◽

Term Survival ◽

Kaplan Meier

In this retrospective study, we analysed the long-term oncological and functional results after extended ray resection for sarcoma of the hand. Recurrence-free and overall survivals were calculated using the Kaplan–Meier method. The function of the operated hand was assessed with the Michigan Hand Questionnaire and compared with the contralateral side. Extended ray resection was performed in 25 out of 168 consecutive patients with soft-tissue and bony sarcomas of the hand. The overall 5- and 10-year, disease-specific survival rates were 86% and 81%, respectively. Local recurrences were observed in two patients. The Michigan Hand Questionnaire score for the affected hand at follow-up in nine patients was 82 points versus 95 for the healthy contralateral hands. We conclude that extended ray resection of osseous sarcomas breaking through the bone into the soft tissue or for soft tissue sarcomas invading bone is a preferable alternative to hand ablation when excision can be achieved with tumour-free margins. Level of evidence: III

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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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FINGERTIP REPLANTATIONS: IMPORTANCE OF VENOUS ANASTOMOSIS AND THE CLINICAL RESULTS

Hand Surgery ◽

10.1142/s0218810409004177 ◽

2009 ◽

Vol 14 (01) ◽

pp. 1-6 ◽

Cited By ~ 26

Author(s):

Takaaki Hasuo ◽

Genzaburo Nishi ◽

Daiji Tsuchiya ◽

Takanobu Otsuka

Keyword(s):

Survival Rate ◽

Nerve Repair ◽

Venous Drainage ◽

Clinical Results ◽

High Survival ◽

Venous Anastomosis ◽

Nail Deformity ◽

Sensory Recovery ◽

Distal Interphalangeal ◽

Protective Sensation

Overall survival rate for 143 digits with complete amputation of the distal phalanx was 78%. Replanted digits that underwent venous anastomosis showed a very high survival rate of 93%. Loss of the distal interphalangeal joint function in subzone IV was significantly inferior to that in subzones II and III. Protective sensation was achieved in 96% of replanted digits. Sensory recovery in the absence of nerve repair was significantly worse for avulsion injury than for crush injury. Nail deformity tended to be increased for replanted digits in subzone III or with crush-type injury. Successful venous anastomosis appears to offer the best way to promote survival of replanted digits. If venous anastomosis is infeasible, a replanted digit can survive with any methods for venous drainage in subzones II and III, but does not survive in subzone IV. To minimise nail deformity, repair of the germinal matrix is necessary.

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The Use of Autogenous Veins for Microsurgical Repair of the Sural Nerve After Nerve Biopsy

Operative Neurosurgery ◽

10.1227/01.neu.0000369657.42680.37 ◽

2010 ◽

Vol 66 (suppl_2) ◽

pp. ons238-ons244 ◽

Cited By ~ 1

Author(s):

Leandro Pretto Flores

Keyword(s):

Sural Nerve ◽

Nerve Repair ◽

Nerve Biopsy ◽

Mean Value ◽

Sural Nerve Biopsy ◽

Sensory Nerves ◽

Control Group ◽

Histopathological Analysis ◽

Sensory Recovery ◽

Monofilament Test

Abstract OBJECTIVE This study evaluates the results of an alternative technique developed to minimize the risk of complications associated with sural nerve biopsy for histopathological analysis. METHODS Twelve subjects underwent sural nerve biopsy and the defect created in the nerve was bridged by a 50-mm-length segment of the saphenous vein; the control group enrolled 23 patients in whom the entire length of the nerve was harvested to be used as autograft for reconstruction of nerves in the upper limb. Sensory reinnervation was quantified by use of the monofilament test and the static 2-point discrimination test, after a follow-up period of 18 months. RESULTS The mean time for recovery of protective sensation was 8.7 months in patients submitted to nerve repair, and 10.3 months in the control group (P > .05). The monofilament test and static 2-point discrimination testing demonstrated a mean value of 3.22 and 8 mm (S3), respectively, in the group who underwent sural nerve repair; and 4.17 and 13 mm (S2), respectively, for the control group (P <.05). CONCLUSION The use of vein as conduits for the repair of the sural nerve did not shorten the time for sensory recovery at the autonomous zone of the nerve; however, the quality of the reinnervation was considered better than the control group. This study suggests that empty veins could be used as conduits to bridge gaps with a length up to 50 mm in cases of injuries of the sural nerve and, possibly, for injuries of other pure sensory nerves as well.

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Comparison of digital nerve sensory recovery after repair using loupe or operating microscope magnification

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414556006 ◽

2014 ◽

Vol 40 (6) ◽

pp. 608-613 ◽

Cited By ~ 7

Author(s):

P. R. Thomas ◽

R. J. Saunders ◽

K. R. Means

Keyword(s):

Nerve Repair ◽

Operating Microscope ◽

Digital Nerve ◽

Nerve Injuries ◽

Level Of Evidence ◽

Visual Analogue Pain ◽

Pain Scores ◽

Significant Difference ◽

Sensory Recovery ◽

Loupe Magnification

Our purpose was to determine whether there was a significant difference in sensory recovery after digital nerve repair using loupe magnification or an operating microscope. We identified patients aged 21–75 who had primary proper digital nerve repairs at least 24 months before our study. A total of 12 patients with 13 digital nerve injuries repaired with loupe magnification and nine patients with 12 digital nerve injuries repaired using the operating microscope, agreed to return for assessment by a therapist blinded to treatment. We found no significant difference in sensory recovery between the two groups as measured by static two-point discrimination, moving two-point discrimination, and Semmes–Weinstein monofilament. There were also no significant differences in average Disabilities of the Arm Shoulder and Hand or visual analogue pain scores. Level of evidence: IV

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Long-term results of Sauvé–Kapandji procedure

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211004459 ◽

2021 ◽

pp. 175319342110044

Author(s):

Lisa Reissner ◽

Andreas Schweizer ◽

Ines Unterfrauner ◽

Lea Estermann ◽

Ladislav Nagy

Keyword(s):

Revision Surgery ◽

Strong Correlation ◽

Distal Radioulnar Joint ◽

Contralateral Side ◽

Long Term Results ◽

Level Of Evidence ◽

Patient Reported ◽

High Incidence

The Sauvé–Kapandji procedure is an established treatment option for distal radioulnar joint dysfunction. We retrospectively analysed 36 patients following Sauvé–Kapandji procedure between 1997 and 2013. Fifteen patients were available for a follow-up after a mean of 13 years (range 6 to 23). Six patients needed revision surgery because of ulnar stump instability. Radiographs and sonography were performed to quantify the instability of the proximal ulnar stump. These showed a radioulnar convergence of 8 mm without weight and 2 mm while lifting 1 kg. Sonographically, the proximal ulnar stump dislocated by 8 mm to the volar side while applying pressure to the palm, compared with 4 mm on the contralateral side. Sonographically measured ulnar stump instability showed a positive strong correlation with the Disabilities of the Arm, Shoulder and Hand questionnaire and Patient-Reported Wrist Evaluations and a negative strong correlation with grip strength and supination torque. Because of the high incidence of revision surgery due to instability of the proximal ulnar stump, we restrict the use of the Sauvé–Kapandji procedure only to very selected cases. Level of evidence: IV

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