Autogenous Vein Graft Repair of Digital Nerve Defects in the Finger
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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.Keywords:
Digital nerve
Nerve repair
Nerve repair
Peripheral nerve injury
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Abstract This chapter describes the principles of peripheral nerve repair by direct repair or nerve graft with specific discussion of assessment, exposure, and techniques of nerve repair. Notes on specific nerve injuries, neuroma management and outcomes are included.
Nerve repair
Neuroma
Epineurial repair
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Nerve repair
Peripheral nerve injury
Nerve Injury
Epineurial repair
Peripheral Nervous System
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Nerve repair
Epineurial repair
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In this review, various conventional nerve repair techniques including direct epineurial repair, grouped fascicular repair, fascicular repair, and nerve grafting are described. The indications for use, as well as the relative advantage and disadvantage, of each technique are discussed. The experimental and clinical evidence from a review of the pertinent literature does not demonstrate a significant difference in outcome of one method over the others. Surgical decisions should be made by a thorough evaluation of all aspects of the nerve injury and surgical methods. All nerve injuries cannot be repaired using only one type of nerve repair method. The surgeon should be familiar with all the techniques described and be prepared to use them under appropriate circumstances.
Nerve repair
Epineurial repair
Peripheral nerve injury
Nerve Injury
Disadvantage
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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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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.
Digital nerve
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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➤ When possible, direct repair remains the current standard of care for the repair of peripheral nerve lacerations. ➤ In large nerve gaps, in which direct repair is not possible, grafting remains the most viable option. ➤ Nerve scaffolds include autologous conduits, artificial nonbioabsorbable conduits, and bioabsorbable conduits and are options for repair of digital nerve gaps that are <3 cm in length. ➤ Experimental studies suggest that the use of allografts may be an option for repairing larger sensory nerve gaps without associated donor-site morbidity.
Epineurial repair
Nerve repair
Digital nerve
Nerve guidance conduit
Standard of care
Peripheral nerve injury
Electrical conduit
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Abstract Peripheral nerve injury may cause gaps between the nerve stumps. Axonal proliferation in nerve conduits is limited to 10–15 mm. Most of the supportive research has been done on rat or mouse models which are different from humans. Herein we review autografts and biomaterials which are commonly used for nerve gap repair and their respective outcomes. Nerve autografting has been the first choice for repairing peripheral nerve gaps. However, it has been demonstrated experimentally that tissue engineered tubes can also permit lead to effective nerve repair over gaps longer than 4 cm repair that was previously thought to be restorable by means of nerve graft only. All of the discoveries in the nerve armamentarium are making their way into the clinic, where they are, showing great potential for improving both the extent and rate of functional recovery compared with alternative nerve guides. © 2010 Wiley‐Liss, Inc. Microsurgery, 2010.
Nerve repair
Epineurial repair
Peripheral nerve injury
Nerve guidance conduit
Nerve Injury
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