Results of primary nerve repair in the upper extremity
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Abstract The results of primary repair of peripheral nerve injury in the upper extremity are reported for 143 nerves in 120 patients, with a mean follow‐up of 24 months. Normal values for static and moving two‐point discrimination were established and related to the person's age. Sensory reeducation was employed routinely in the postoperative rehabilitation program. Moving two‐point discrimination recovered to a better level in 61%, the same level in 38%, and a worse level in 1% than static two‐point discrimination after nerve repair. Results for digital, median, ulnar, and radial nerve repairs are reported.Keywords:
Nerve repair
Radial nerve
Peripheral nerve injury
Digital nerve
A retrospective comparison of twelve patients with radial nerve transection treated by nerce repair, and thirteen similar patients treated by tendon transfer only, showed an average time to recovery of 7.5 months after nerve repair, and eight weeks after transfer. In view of this, a policy of early tendon transfer instead of radial nerve suture is advised. Results are reported in nine patients who had tendon transfers at an average of thirteen days after nerve injury.
Radial nerve
Nerve repair
Tendon transfer
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Purpose: The brachial plexus block through the humeral canal as described by Dupre is indicated in hand and forearm surgery. This block requires a multi-stimulation technique that emphasizes the necessity of a rigorous and safe technique. Nerve injury associated with regional anesthesia can entail significant morbidity for patients. Thus, we investigated the brachial block sequence in terms of unintended nerve stimulation as a surrogate of potential nerve injury. Methods: Sixty patients were randomly allocated in two groups of 30. In Group I the radial nerve was blocked before the ulnar nerve. In Group II the ulnar nerve was blocked before the radial nerve. During the radial nerve approach we recorded, if present, an ulnar nerve response. During the ulnar nerve approach we recorded, if present, a radial nerve response. Results: In Group I while looking for the radial nerve, in 50% of the cases, an ulnar motor response was recorded. In Group II while looking for the ulnar nerve, a radial motor response was recorded in 10% of the cases. Conclusion: Our results indicate that the radial nerve should be blocked before the ulnar nerve when performing a brachial plexus block at the humeral canal.
Radial nerve
Brachial plexus block
Motor nerve
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Digital nerve
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The case of a fifteen-year-old child where the delay between division and successful repair of the ulnar nerve was nine years is presented. This case and a review of the literature emphasise the importance of repairing nerves in children irrespective of the time interval between division and repair.
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Radial nerve
Musculocutaneous nerve
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We report the results of examination of patients before primary and secondary unilateral digital nerve repair. Two-point discrimination was uniformly recorded. The results show that significant overlap of adjacent digital nerves is common and this has important implications for interpretation of results after repair. Recommendations are made regarding the evaluation of outcome following surgery.
Digital nerve
Nerve repair
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Twenty-two digital nerve repairs were performed in the finger using autogenous vein grafts. Eighty-two percent of the repairs were available for follow-up. Results of sensibility return were assessed using moving two-point discrimination, Semmes-Weinstein monofilaments, and vibratory testing. Two-point discrimination averaged 4.6 mm for 11 acute digital nerve repairs using vein conduits 1 to 3 cm in length. Delayed digital nerve repair with vein conduits yielded poor results. Semmes-Weinstein values demonstrated comparable levels of return of slowly adapting fiber/receptors to the quickly adapting fiber/receptors, as evidenced by moving two-point discrimination tests. Vibratory sensibility was present in all. A review of previous experiences with end-to-end digital neurorrhaphies and digital nerve grafting suggests that repair of 1− to 3-cm gaps in digital nerves with segments of autologous vein grafts appears to give comparable results to nerve grafting. Further laboratory and clinical research is necessary to better define the role of interpositional vein conduits for repair of peripheral nerves.
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Autogenous vein graft repair of digital nerve defects in the finger: a retrospective clinical study.
Twenty-two digital nerve repairs were performed in the finger using autogenous vein grafts. Eighty-two percent of the repairs were available for follow-up. Results of sensibility return were assessed using moving two-point discrimination, Semmes-Weinstein monofilaments, and vibratory testing. Two-point discrimination averaged 4.6 mm for 11 acute digital nerve repairs using vein conduits 1 to 3 cm in length. Delayed digital nerve repair with vein conduits yielded poor results. Semmes-Weinstein values demonstrated comparable levels of return of slowly adapting fiber/receptors to the quickly adapting fiber/receptors, as evidenced by moving two-point discrimination tests. Vibratory sensibility was present in all. A review of previous experiences with end-to-end digital neurorrhaphies and digital nerve grafting suggests that repair of 1- to 3-cm gaps in digital nerves with segments of autologous vein grafts appears to give comparable results to nerve grafting. Further laboratory and clinical research is necessary to better define the role of interpositional vein conduits for repair of peripheral nerves.
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Nerve repair
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Current standard management of a cut digital nerve is end-to-end microsurgical nerve coaptation where possible. A recent systematic review of adult digital nerve injuries that were either repaired or left unrepaired showed that the evidence for good nerve recovery or improved function following nerve repair is poor. In the 30 studies included, only 24% of repaired nerves regained sensory recovery close to or equivalent to estimated pre-injury levels. Neuroma rates were the same in those nerves repaired (4.6%) and those not repaired (5%). Questions under debate include proper assessment methods of outcomes, decision making for repair or no repair to different fingers or the thumb, levels of injury, age, and hand dominance. This review summarizes the major evidence available and debates the surgical dogma that surrounds this injury.
Neuroma
Digital nerve
Nerve repair
Nerve Injury
Epineurial repair
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This report describes two incidental findings of aberrant branches of the radial digital nerves in the middle finger of a 52-year-old man who cut himself with a grinding machine, and in the index finger of a 45-year-old female who sustained a flexor sheath infection following a dog bite. In both patients, two equally sized radial digital nerves were found and both nerves originated from one common digital nerve.
Digital nerve
Radial nerve
Middle finger
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