scholarly journals Nerve Anastomosis-our Experience of Thirteen Cases

2019 ◽  
Vol 9 (1) ◽  
pp. 33-38
Author(s):  
Kaisar Haroon ◽  
Tania Taher ◽  
Shafiul Alam ◽  
Abdullah Alamgir ◽  
Md Arif Reza ◽  
...  
Keyword(s):  
Observational Study ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Motor Function ◽  
Peripheral Nerve Injury ◽  
Common Condition ◽  
Life Threatening ◽  
Nerve Anastomosis ◽  
Grade 3

Background: Peripheral nerve injury is a common condition. Though it is not life threatening, it may cause disability to a person. In this study we have analysed our experience of anastomosis of injured nerves. Materials and methods: This is an observational study that was done within a period from January 2014 to December 2018. 13 patients with injury to the nerves were operated upon. There were 11 male and 2 female patients. All patients were followed up in OPD upto one and half years. 5 patients were lost from follow up, of these, two were female. Results: After surgery, touch returned in 5 patients. Of motor function,there was no improvement in 1 patient, grade 1 in 1 patient, grade 2 in 4 patients and grade 3 in 3 patients. Those who came earlier had better outcome, so had those with small injury and distal to the limb. Conclusion: peripheral nerve injury has to be repaired as soon as possible. The sooner it can be done the better will be the outcome. Bang. J Neurosurgery 2019; 9(1): 33-38

Changes in Crossed Spinal Reflexes After Peripheral Nerve Injury and Repair

2002 ◽  
Vol 87 (4) ◽  
pp. 1763-1771 ◽  
Author(s):  
Antoni Valero-Cabré ◽  
Xavier Navarro
Keyword(s):  
Sciatic Nerve ◽  
Action Potential ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Tibialis Anterior ◽  
Tibial Nerve ◽  
Spinal Reflexes ◽  
Injury And Repair

We investigated the changes induced in crossed extensor reflex responses after peripheral nerve injury and repair in the rat. Adults rats were submitted to non repaired sciatic nerve crush (CRH, n = 9), section repaired by either aligned epineurial suture (CS, n = 11) or silicone tube (SIL4, n = 13), and 8 mm resection repaired by tubulization (SIL8, n = 12). To assess reinnervation, the sciatic nerve was stimulated proximal to the injury site, and the evoked compound muscle action potential (M and H waves) from tibialis anterior and plantar muscles and nerve action potential (CNAP) from the tibial nerve and the 4th digital nerve were recorded at monthly intervals for 3 mo postoperation. Nociceptive reinnervation to the hindpaw was also assessed by plantar algesimetry. Crossed extensor reflexes were evoked by stimulation of the tibial nerve at the ankle and recorded from the contralateral tibialis anterior muscle. Reinnervation of the hindpaw increased progressively with time during the 3 mo after lesion. The degree of muscle and sensory target reinnervation was dependent on the severity of the injury and the nerve gap created. The crossed extensor reflex consisted of three bursts of activity (C1, C2, and C3) of gradually longer latency, lower amplitude, and higher threshold in control rats. During follow-up after sciatic nerve injury, all animals in the operated groups showed recovery of components C1 and C2 and of the reflex H wave, whereas component C3 was detected in a significantly lower proportion of animals in groups with tube repair. The maximal amplitude of components C1 and C2 recovered to values higher than preoperative values, reaching final levels between 150 and 245% at the end of the follow-up in groups CRH, CS, and SIL4. When reflex amplitude was normalized by the CNAP amplitude of the regenerated tibial nerve, components C1 (300–400%) and C2 (150–350%) showed highly increased responses, while C3 was similar to baseline levels. In conclusion, reflexes mediated by myelinated sensory afferents showed, after nerve injuries, a higher degree of facilitation than those mediated by unmyelinated fibers. These changes tended to decline toward baseline values with progressive reinnervation but still remained significant 3 mo after injury.

scholarly journals 32. Follow-Up Study in Fifty-One Cases of Peripheral Nerve Injury

1965 ◽  
Vol 7 ◽  
pp. 175-175
Author(s):  
Kunikazu SUHARA ◽  
Shigeo UEDA ◽  
Yoshihiro KAWAMURA
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Follow Up Study

Electromyographic Biofeedback in Motor Function Recovery After Peripheral Nerve Injury: An Integrative Review of the Literature

2018 ◽  
Vol 43 (4) ◽  
pp. 247-257 ◽  
Author(s):  
Rafael Jardim Duarte-Moreira ◽  
Kamyle Villa-Flor Castro ◽  
Cleber Luz-Santos ◽  
José Vicente Pereira Martins ◽  
Katia Nunes Sá ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Motor Function ◽  
Peripheral Nerve Injury ◽  
Integrative Review ◽  
Review Of The Literature ◽  
Electromyographic Biofeedback ◽  
Function Recovery

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.

Functional Outcome Following Traumatic Peripheral Nerve Injury Repair in a Tertiary Care Hospital in South India - An Observational Study

2021 ◽  
Vol 8 (25) ◽  
pp. 2197-2202
Author(s):  
Joyal Jose ◽  
Sabu Chaniveliyil Parameswaran ◽  
Aniraj Rajappan
Keyword(s):  
Observational Study ◽  
Peripheral Nerve ◽  
Functional Outcome ◽  
Median Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Nerve Repair ◽  
P Value ◽  
Nerve Injuries ◽  
Motor Outcome

BACKGROUND Peripheral nerve injuries (PNIs) often accompany trauma to limbs and is a major cause of morbidity. Various surgical techniques are described for nerve repair and various factors influence the functional outcome after repair. This study intends to assess the functional outcome following PNI repair and various factors affecting the final outcome post repair. In this study we wanted to assess the functional outcome of PNI repair done at our institute. METHODS This is a prospective observational study conducted at the Department of Plastic and Reconstructive Surgery, Government Medical College, Thiruvananthapuram, India, from September 2017 to September 2019 (24 months) in patients with a diagnosis of traumatic peripheral nerve injury. Data collected were analysed by statistical programme for social sciences (SPSS) version 20. Quantitative variables were expressed in mean & standard deviation (SD) and qualitative variables were expressed in proportions. Associations were tested by chi-square test. RESULTS A total of 100 patients were studied. Overall satisfactory sensory outcome was found to be 45.2% in median nerve and 45.5 % in ulnar nerve injuries (P value - 0.492). Overall satisfactory motor outcome was found to be 45.2 % in median nerve and 36.3 % in ulnar nerve injuries (P value - 0.391). Age < 40 years was found to be significantly associated with a good sensory and motor recovery. Diabetes mellitus was associated with a poor sensory and motor outcome compared to patients without any comorbidities. Use of nerve grafts was associated with less sensory recovery compared to primary nerve coaptation (P value - 0.496). Nerve repairs done between 4 - 7 days of injury had better sensory and motor outcome. CONCLUSIONS Traumatic peripheral nerve repair has a variable functional outcome and is dependent on various factors like age and other patient related factors, mechanism of injury and the type of nerve repair. Accurate diagnosis, attention to detail and timely intervention can improve the overall functional outcome. KEYWORDS Peripheral Nerve Injury, Nerve Repair, Functional Outcome

scholarly journals 4-AP-3-MeOH Promotes Structural and Functional Spontaneous Recovery in the Acute Sciatic Nerve Stretch Injury

Dose-Response ◽  
2020 ◽  
Vol 18 (1) ◽  
pp. 155932581989925
Author(s):  
Yan Chen ◽  
Weidong Wang ◽  
Zhimin Zhao ◽  
Dong Ren ◽  
Danmou Xin
Keyword(s):  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Motor Function ◽  
Peripheral Nerve Injury ◽  
Spontaneous Recovery ◽  
Sciatic Nerve Injury ◽  
Stretch Injury ◽  
Injured Nerve ◽  
Injury Model

Background: 4-AP-3-MeOH, a derivative of 4-aminopyridine, was developed and demonstrated to prevent nerve pulse diffusion due to myelin damage and significantly enhance axonal conduction following nerve injury. Currently, repurposing the existing drug such as 4-AP-3-MeOH to restore motor function is a promising and potential therapy of peripheral nerve injury. However, to evaluate drug effect on sciatic nerve injury is full of challenge. Methods: Sciatic functional index was used to determine and measure the walking track in the stretch injury model. Nerve conductivity was performed by electrical stimulation of a nerve and recording the compound muscle action potential. Myelin thickness and regeneration was imaged and measured with transmission electron microscopy (TEM). Results: In this study, we developed a sciatic nerve injury model to minimize the spontaneous recovery mechanism and found that 4-AP-3-MeOH not only improved walking ability of the animals but also reduced the sensitivity to thermal stimulus. More interesting, 4-AP-3-MeOH enhanced and recovered electric conductivity of injured nerve; our TEM results indicated that the axon sheath thickness was increased and myelin was regenerated, which was an important evidence to support the recovery of injured nerve conductivity with 4-AP-3-MeOH treatment. Conclusions: In summary, our studies suggest that 4-AP-3-MeOH is a viable and promising approach to the therapy of peripheral nerve injury and in support of repurposing the existing drug to restore motor function.

scholarly journals Peripheral Nerve Injury-Induced Astrocyte Activation in Spinal Ventral Horn Contributes to Nerve Regeneration

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Changhui Qian ◽  
Dandan Tan ◽  
Xianghai Wang ◽  
Lixia Li ◽  
Jinkun Wen ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Regeneration ◽  
Nerve Injury ◽  
Motor Function ◽  
Peripheral Nerve Injury ◽  
Early Stage ◽  
Ventral Horn ◽  
Astrocyte Activation ◽  
Neurotrophin 3 ◽  
Function Recovery

Accumulating evidences suggest that peripheral nerve injury (PNI) may initiate astrocytic responses in the central nervous system (CNS). However, the response of astrocytes in the spinal ventral horn and its potential role in nerve regeneration after PNI remain unclear. Herein, we firstly illustrated that astrocytes in the spinal ventral horn were dramatically activated in the early stage following sciatic nerve injury, and these profiles were eliminated in the chronic stage. Additionally, we found that the expression of neurotrophins, including brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and neurotrophin-3 (NT-3), also accompanied with astrocyte activation. In comparison with the irreversible transected subjects, astrocyte activation and the neurotrophic upregulation in the early stage were more drastic in case the transected nerve was rebridged immediately after injury. Furthermore, administering fluorocitrate to inhibit astrocyte activation resulted in decreased neurotrophin expression in the spinal ventral horn and delayed axonal regeneration in the nerve as well as motor function recovery. Overall, the present study indicates that peripheral nerve injury can initiate astrocyte activation accompanied with neurotrophin upregulation in the spinal ventral horn. The above responses mainly occur in the early stage of PNI and may contribute to nerve regeneration and motor function recovery.

Evaluation of surgical treatment for neuropathic pain from neuroma in patients with injured peripheral nerves

2018 ◽  
Vol 128 (4) ◽  
pp. 1235-1240 ◽  
Author(s):  
Valérie Decrouy-Duruz ◽  
Thierry Christen ◽  
Wassim Raffoul
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Revision Surgery ◽  
Peripheral Nerve Injury ◽  
Elective Surgery ◽  
European Federation ◽  
The Mean

OBJECTIVEChronic neuropathic pain after peripheral nerve injury is a major clinical problem. Its management is difficult, and therapeutic approaches vary and include oral medication, neurostimulation, and surgery. The aim of this study was to assess the adequacy of surgical nerve revision in a large series of patients with long-term follow-up.METHODSThe authors reviewed the charts of 231 patients (335 nerve injuries) who experienced neuropathic pain after peripheral nerve injury and underwent surgery for nerve revision at the authors’ institution between 1997 and 2012. The following parameters were recorded for each patient: history, location, duration, and severity of the pain and details of nerve revision surgery. In addition, patients were invited to participate in a follow-up consultation and were asked to score their pain at that time. Current medications and examination findings were also documented.RESULTSElective surgery was the source of nerve injury for 55.4% of the patients. The lower extremity was the most commonly involved anatomical region (54.3%), followed by the lower abdomen (16.4%) and the thoracic region (13%). The mean time between the onset of injury and revision surgery was 48 months. On average, 1.3 injured nerves per patient were explored, and surgery was performed 1.2 times per patient. Each nerve underwent revision 1.1 times on average. Neuromas-in-continuity and scar-tethered nerves were observed in 205 nerves (61%) and terminal neuromas were observed in 130 nerves (39%). The authors performed 186 (56%) neurolyses and 149 (44%) neuroma resections and translocations. The mean follow-up of the 127 (55%) patients who agreed to come back for a consultation was 68 months. These patients indicated an average pain decrease of 4 points in the visual analog scale (VAS) score. Pain relief greater than a 2-point decrease on the VAS, a criterion for a successful treatment according to the European Federation of Neurological Societies guidelines, was encountered in 80% of patients. Pain relief did not vary in a statistically significant way with regard to surgical technique, age and sex of the patient, affected nerve, or time between trauma and surgery. Before surgery, 76% of the patients were on a regimen of paracetamol and/or NSAIDs and 44% received opiates, while after nerve revision only 37% still required simple analgesia and 14% needed opiates.CONCLUSIONSBearing in mind that medication achieves satisfying pain relief in only 30%–40% of patients with neuropathic pain, surgery must be considered as an effective alternative therapy. No objective criteria were shown to be factors of poor prognosis. Systematic preoperative clinical mapping of the injured nerves and diagnostic nerve blocks could improve the primary success rate of the surgery.

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