Prolonging Nerve Grafts Using Chemical Extracted Muscle-in-vein with Vein Window Method Chemical acellular nerve grafts

2018 ◽  
Vol 68 (12) ◽  
pp. 2936-2940
Author(s):  
Irina Mihaela Jemnoschi Hreniuc ◽  
Camelia Tamas ◽  
Sorin Aurelian Pasca ◽  
Bogdan Ciuntu ◽  
Roxana Ciuntu ◽  
...  
Keyword(s):  
Classical Group ◽  
Donor Site ◽  
Good Alternative ◽  
Nerve Graft ◽  
Male Rats ◽  
Chemical Extraction ◽  
Nerve Grafting ◽  
Nerve Grafts ◽  
Local Resources ◽  
Window Method

Nerve injuries are a common pathology in hand trauma. The consequences are drastic both for patients and doctors/medical system. In many cases direct coaptation is impossible. A nerve graft should be used in the case of a neuroma, trauma or tumor, for restoration of nervous influx. The aim of this study is demonstrate that by grafting restant nerve stumps with muscle-in-vein nerve grafts we obtain good result in terms of functional and sensibility recovery and also our method �window-vein� is a good way of prolonging nerve grafts. The method of study is experimental. We worked in the laboratory in optimal conditions for carrying out of muscles-in-vein nerve grafts (nerve grafts size 1.5 cm-3 cm). We used acellular muscle grafts with the chemical extraction method.The study was conducted on experimental animals (Wistar male rats).We used 30 experience animals in 3 equal groups (classical group and muscle-in-vein nerve grafts-2 nerve grafts of 1,5 cm central sutured and the third group with muscle-in-vein nerve grafts, window-vein method, 3 cm). At 4 and respectively 6 weeks postoperative at the quality tests we observed the progress with the footprint test. The operated hind in comparison with the healthy hind was 86% recovered and similar with classic nerve grafts. Quantitatively the number of regenerated axons in the group with muscle-in-vein nerve grafts was significant bigger in comparison with the classical group (15%).The method using muscle-in-vein nerve graft with windows-vein it�s a good alternative for nerve grafting in comparison with classical nerve grafting. When the local possibilities are limited, this method is good for prolonging the grafts. The relationship between cost and benefit in this case it�s an advantage because we use the local resources of the affected area. The motor results of nerve grafting ingroup 2 in comparison with group 3 were similar and in some cases better in group 1. Grafting with MVNG offers a better alternative for donor site regeneration in comparison with classical nerve grafts. This method is useful to prolong nerve grafts without adding morbidity.

scholarly journals Schwannoma in the Upper Limbs

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Chris Yuk Kwan Tang ◽  
Boris Fung ◽  
Margaret Fok ◽  
Janet Zhu
Keyword(s):  
Peripheral Nerves ◽  
Motor Nerve ◽  
Distal Region ◽  
Nerve Graft ◽  
Nerve Grafting ◽  
Nerve Grafts ◽  
Functional Deficit ◽  
Patient Consent ◽  
New System ◽  
Mixed Nerve

Schwannomas are the commonest tumours of peripheral nerves. Despite the classical description that schwannomas are well encapsulated and can be completely enucleated during excision, a portion of them have fascicular involvement and could not be completely shelled out. A retrospective review for 8 patients was carried out over 10 years. 75% of schwannoma occurred over the distal region of upper limb (at elbow or distal to it). It occurs more in the mixed nerve instead of pure sensory or motor nerve. 50% of patients had mixed nerve involvement. Fascicular involvement was very common in schwannoma (75% of patients). Removal of the tumour with fascicles can cause functional deficit. At present, there is no method (including preoperative MRI) which can predict the occurrence of fascicular involvement; the authors therefore proposed a new system to stratify patients who may benefit from interfascicular nerve grafts. In this group of patients, the authors strongly recommend that the possibility and option of nerve graft should be discussed with patients prior to schwannoma excision, so that nerve grafting could be directly proceeded with patient consent in case there is fascicular involvement of tumour found intraoperatively.

Vascularised Versus Conventional Nerve Grafting: A Case Report

1987 ◽  
Vol 12 (2) ◽  
pp. 218-220
Author(s):  
J. G. BOOBMAN ◽  
P. J. SYKES
Keyword(s):  
Case Report ◽  
Nerve Graft ◽  
The Other ◽  
Cutaneous Nerve ◽  
Nerve Grafting ◽  
Nerve Grafts ◽  
Sensory Recovery ◽  
Lateral Cutaneous Nerve

A case is described in which two lengths of the lateral cutaneous nerve of the forearm were used, one vascularised and the other not, to reconstruct the two digital nerves of the thumb. The sensory recovery of the two nerves was compared, and the vascularised nerve graft found to result in better sensation. This finding provides further support for the value of vascularised nerve grafts.

Surgical Management of Iatrogenic Facial Nerve Injuries

1994 ◽  
Vol 111 (5) ◽  
pp. 606-610 ◽  
Author(s):  
J. Douglas Green ◽  
Clough Shelton ◽  
Derald E. Brackmann
Keyword(s):  
Facial Nerve ◽  
Surgical Management ◽  
Nerve Graft ◽  
Nerve Grafting ◽  
Nerve Injuries ◽  
Neural Repair ◽  
Nerve Grafts ◽  
Facial Nerve Injuries ◽  
Direct Anastomosis ◽  
Grade Iii

Surgical management of an latrogenic facial nerve injury represents a significant challenge for the otologic surgeon. The decision to perform facial nerve grafting is a difficult one and is based on the extent of injury to the nerve. We conducted a review of 22 patients who had sustained latrogenic facial nerve injuries during otologic surgery that required surgical exploration. The facial nerve was transected more than half its diameter in 13 of the patients. All of these patients' nerves were repaired either with direct reanastomosis of the facial nerve or with a cable nerve graft. The transection was less than 50% in nine of the patients in the study group. Eight of these patients underwent only decompression of the facial nerve. No patient with a neural repair (direct anastomosis or cable graft) had better than a House grade III result. All of the patients undergoing direct anastomosis of the nerve obtained a House grade III result. The most common result in patients undergoing cable nerve grafting was a House grade IV. The only patients with normal or near-normal facial nerve function (House grade I or II) had only decompression of the facial nerve. Five of the eight patients undergoing decompression had results similar to those undergoing cable nerve grafts. We conclude that acceptable results can be obtained when the facial nerve is repaired by direct anastomosis or a cable nerve graft. These results are comparable with those of patients treated with decompression only. When in doubt as to the extent of injury, it is preferable to repair the facial nerve, because the extent of injury may be underestimated.

scholarly journals Median Nerve Repair with Autologous Sciatic Nerve Graft: A Case Report

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-2 ◽  
Author(s):  
Brian T. Ragel ◽  
Gregory C. Park ◽  
Sid Brevard
Keyword(s):  
Sciatic Nerve ◽  
Lower Extremity ◽  
Median Nerve ◽  
Nerve Repair ◽  
Treatment Options ◽  
Donor Site ◽  
Nerve Graft ◽  
Military Hospital ◽  
Nerve Grafting ◽  
Lower Extremity Injuries

Background. Peripheral nerve injury treatment options are limited to primary nerve repair, nerve grafting, and tendon transfers. In this case, a large suitable donor site was easily accessible and delayed grafting was indicative of poor prognosis. Case Description. A 25-year-old soldier presented to a military hospital in Afghanistan following a roadside bomb attack. The patient had a medial shrapnel wound in the bicipital groove with a cool pulseless hand and catastrophic lower extremity injuries. Bilateral above-the-knee amputations (AKAs) and exploration of the medial shrapnel wound were undertaken. A 7 cm traumatic defect in the median nerve was repaired with interpositional sciatic nerve graft harvested from the AKA. Conclusion. Recovery of motor function after nerve grafting is dependent on motor axons reinnervating target muscles, making proximal nerve injuries problematic. We identify a potential nerve harvest site in patients with lower extremity amputations in need of long segment nerve repairs.

Digital Nerve Grafting Using the Dorsal Sensory Branch of the Ulnar Nerve

1985 ◽  
Vol 10 (1) ◽  
pp. 37-40 ◽  
Author(s):  
T. L. GREENE ◽  
J. B. STEICHEN
Keyword(s):  
Ulnar Nerve ◽  
Hand Function ◽  
Nerve Graft ◽  
The Other ◽  
Nerve Grafting ◽  
Digital Nerve ◽  
Nerve Grafts ◽  
Neuroma Formation

The dorsal sensory branch of the ulnar nerve has been found to have the appropriate size and sufficient length for use as a digital nerve graft. This donor nerve was utilised fifteen times in twelve patients for the bridging of defects in thirteen digital nerves of the fingers. After an average follow-up of 23.2 months, only one patient failed to achieve any two point discrimination in the area supplied by the involved digital nerve. The other eleven patients had an average two point discrimination of 9.5 mm with a range of 5 to 18 mm. Painful neuroma formation or loss of hand function related to the use of the dorsal sensory branch of the ulnar nerve as a donor for digital nerve grafts was not encountered.

An Experimental Study of Contralateral C7 Root Transfer with Vascularized Nerve Grafting to Treat Brachial Plexus Root Avulsion

1994 ◽  
Vol 19 (1) ◽  
pp. 60-66 ◽  
Author(s):  
L. CHEN ◽  
Y-D. GU
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Phrenic Nerve ◽  
Nerve Transfer ◽  
Nerve Graft ◽  
Functional Evaluation ◽  
Nerve Grafting ◽  
Root Avulsion ◽  
Nerve Grafts ◽  
Healthy Side

Experimental rat models of simulated brachial plexus injuries were devised to compare the effect of contralateral C7 root transfer with phrenic neurotization. The effect of vascularized nerve grafting (VNG) was also compared with the use of conventional nerve grafts (CNG) in the treatment of root avulsion of the brachial plexus. 160 rats were randomly divided into four groups of 40 each; contralateral C7 root transfer with a vascularized ulnar nerve graft (C7-VNG), contralateral C7 root transfer with conventional ulnar nerve grafting (C7-CNG), ipsilateral phrenic nerve transfer with a vascularized ulnar nerve graft (P-VNG) and ipsilateral phrenic nerve transfer with conventional ulnar nerve grafting (P-CNG). Electrophysiological and histological examinations and functional evaluation were performed at different post-operative intervals. C7 root transfer was found to be superior to phrenic nerve transfer and VNG superior to CNG. Severance of the C7 nerve root was not found to affect limb function on the healthy side.

scholarly journals Peripheral Nerve Transplantation: The Effects of Predegenerated Grafts and Immunosuppression

1992 ◽  
Vol 3 (1) ◽  
pp. 39-49 ◽  
Author(s):  
Thomas E. Trumble
Keyword(s):  
Cyclosporin A ◽  
Donor Site ◽  
Flexion Contracture ◽  
Brown Norway ◽  
Control Group ◽  
Neurologic Recovery ◽  
Nerve Grafts ◽  
Nerve Transplantation ◽  
Joint Flexion ◽  
Tissue Rejection

Research involving nerve transplantation has shown that tissue rejection limits the neurologic recovery unless the host is immunosuppressed. This study investigates an alternative to permanent or temporary immunosuppression using a rat model with nerve transplants from Brown- Norway rat donors to bridge defects in the sciatic nerve of Lewis rat recipients as these two inbred strains differ at both major and minor histocompatibility loci.The specific aim of this study was to evaluate if predegenerated nerve grafts decreased the tissue rejection and improved the neurologic recovery of animals with allogenic nerve grafts to avoid the problems associated with either short- or long-term immunosuppression. The animals in the experimental groups received cyclosporin-A, predegencrated grafts, both, or neither. The predegenerated grafts were produced by division of the nerve three weeks prior to grafting to allow for Wallerian degeneration to occur. The outcome was assessed by measurements stressing functional recovery (sensory testing, gait analysis, joint flexion contracture), studies of muscle recovery (muscle weight and hydroxyproline concentration), and histologic studies (axonal counts and inflammatory reaction). The animals receiving the predegenerated grafts without cyclosporin did have an improved recovery (joint flexion contracture 35° ± 8 ° and hydroxyproline ratio 1.52 ± 0.16) as compared to the joint flexion contractures and hydroxyproline ratios of the allograft group of animals without either cyclosporin- A or pretreatment and the ungrafted control group (47° ± 18°, 1.68 ± 0.34, and 53° ±15° ,4.50 ± 0.27, respectively, p < 0.01). However, all the isograft groups and allograft groups with cyclosporin-A, regardless of whether the graft had been predegenerated or not, had greater neurologic recovery than the allograft group with predegenerated grafts but without cyclosporin-A by the same parameters (p < 0.01). Allograft groups with short-term immunosuppression with cyclosporin-A did as well as isograft groups, and isograft groups with predegenerated grafts did not do any better than isografts without pretreatment (p <0.01).Clinical Relevance:Predegenerated nerve allografts will allow for greater neurologic recovery than standard nerve allografts avoiding the complications of immunosuppression, but the level of recovery is less than that of recipients of nerve allografts with immunosuppression. Nerve transplants would avoid the problems of neurologic deficits at the donor site and allow multiple large deficits to be treated easily.

Outcome of axillary nerve injuries treated with nerve grafts

2011 ◽  
Vol 36 (7) ◽  
pp. 535-540 ◽  
Author(s):  
M. Okazaki ◽  
A. Al-Shawi ◽  
C. R. Gschwind ◽  
D. J. Warwick ◽  
M. A. Tonkin
Keyword(s):  
Reliable Method ◽  
Axillary Nerve ◽  
Nerve Grafting ◽  
Nerve Injuries ◽  
Nerve Grafts ◽  
The Mean

This study evaluates the outcome of axillary nerve injuries treated with nerve grafting. Thirty-six patients were retrospectively reviewed after a mean of 53 months (minimum 12 months). The mean interval from injury to surgery was 6.5 months. Recovery of deltoid function was assessed by the power of both abduction and retropulsion, the deltoid bulk and extension lag. The deltoid bulk was almost symmetrical in nine of 34 cases, good in 22 and wasted in three. Grade M4 or M5* was achieved in 30 of 35 for abduction and in 32 of 35 for retropulsion. There was an extension lag in four patients. Deltoid bulk continued to improve with a longer follow-up following surgery. Nerve grafting to the axillary nerve is a reliable method of regaining deltoid function when the lesion is distal to its origin from the posterior cord.

Segmental Defects in Peripheral Nerves Xenotransplantation

2018 ◽  
Vol 2 (5) ◽  
pp. 01-02
Author(s):  
Ryan William
Keyword(s):  
Graft Rejection ◽  
Peripheral Nerves ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Clinical Use ◽  
Nerve Grafts ◽  
Surgery Research ◽  
The Ideal

Segmental defects in peripheral nerves that cannot be sutured directly require the use of nerve grafts. The ideal option for repair is nerve auto grafting, but there are some obvious disadvantages related to its use, such as lack of availability and donor site morbidity. The next step to consider for reconstruction is the use of nerve allografts, but they are also limited for clinical use, and they present with the added problem of graft rejection. Considering these limitations to the use of nerve autografts and allografts, clinical surgery research has turned to nerve xenotransplantation, which offers a potentially unlimited source of donor nerves.

Free Flaps in the Reconstruction of Hand and Distal Forearm Injuries

1992 ◽  
Vol 17 (2) ◽  
pp. 185-188 ◽  
Author(s):  
A. REIGSTAD ◽  
K. R. HETLAND ◽  
K. BYE ◽  
M. RØKKUM
Keyword(s):  
Donor Site ◽  
Hand Surgery ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Medium Size ◽  
Nerve Grafts ◽  
Partial Necrosis ◽  
Tendon Grafts ◽  
Large Skin ◽  
Forearm Injuries

We report a series of 32 free flap reconstructions following acute hand and forearm trauma. The series consists of two dorsalis pedis flaps, four scapular flaps and 26 lateral arm flaps. One flap became infected and failed completely, and a partial necrosis occurred in another flap. The transfers covered large skin defects, exposed tendons, tendon grafts, bone, bone grafts, joints, nerves and nerve grafts. The donor site morbidity was negligible. Our study shows that free microvascular flaps are a safe and convenient alternative to conventional flaps in hand surgery. The lateral arm flap seems very suitable for small and medium size defects.

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