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.

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.

Use of an intact sensory nerve to bridge a motor nerve defect: an experimental study

2006 ◽  
Vol 104 (5) ◽  
pp. 804-809 ◽  
Author(s):  
Serçin Tirelioğlu ◽  
Serhat Özbek ◽  
Mesut Özcan ◽  
M. Ayberk Kurt ◽  
Bezhat Noyan
Keyword(s):  
Experimental Study ◽  
Distal Part ◽  
Motor Nerve ◽  
Nerve Repair ◽  
Sensory Nerve ◽  
Nerve Grafting ◽  
Nerve Stump ◽  
Electrophysiological Tests ◽  
Experimental Use ◽  
Mixed Nerve

Object End-to-side neurorrhaphy has recently became popular for peripheral nerve repair. Although this method is mainly indicated in nerve defects in which there is an absent proximal nerve stump, bridging a motor nerve defect by coapting the proximal and distal ends of the defect to a neighboring mixed nerve in an end-to-side fashion has been another experimental use of this method. In this situation, however, the source of the regenerating axons is unclear because the axons in both the proximal end of the defect and the bridging intact nerve have the capacity for regeneration. The goal of this study was to identify the source of the regenerating axons. Methods In this experimental study, the authors used a sensory nerve to bridge a motor nerve defect so that they could elucidate the source of the regenerating motor axons in the distal part of the motor nerve. One advantage of using a sensory nerve was that it eradicated the risk of damaging another motor nerve. Tests used in the analysis included gait evaluation, electrophysiological tests, and histological assessment. Conclusions Results of this study showed that, in the rat model, a sensory nerve can be used to bridge a motor nerve defect, thereby eliminating the need for nerve grafting.

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.

Microneurovascular Reconstruction for Facial Reanimation

2019 ◽  
pp. 393-402
Author(s):  
Michael Klebuc
Keyword(s):  
Sural Nerve ◽  
Motor Nerve ◽  
Muscle Flap ◽  
Nerve Graft ◽  
Muscle Flaps ◽  
Nerve Grafts ◽  
Free Muscle Flap ◽  
Graft Harvest ◽  
Facial Reanimation ◽  
Sural Nerve Graft

Microneurovascular muscle flaps can be effectively employed to reanimate the paralyzed mid-face. This chapter explores the indications and contraindications for free muscle flap smile restoration. Various sources of innervation are examined including the motor nerve to masseter and cross-face nerve grafts, as are different muscle flap donor sites. A detailed description of facial nerve exploration, sural nerve graft harvest, and the cross-face nerve graft procedure are provided. Single and two-staged facial reanimation procedures utilizing free gracilis muscle flaps are also described in detail, including technical nuances, postoperative care, and physical therapy. The technique is well suited for individuals whose native muscles of facial expression have failed to develop in utero, undergone irreversible atrophy, sustained significant trauma, or have been sacrificed during oncologic resection.

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.

Repair of Rabbit Facial Nerve with Amniotic Extracellular Matrix Based on Biological Material

2011 ◽  
Vol 322 ◽  
pp. 169-172
Author(s):  
Zhen Gao ◽  
Xiao Ting Luo ◽  
Nian Sheng Li ◽  
Wei Deng ◽  
Shu Mei Li
Keyword(s):  
Extracellular Matrix ◽  
Facial Nerve ◽  
Nerve Conduction ◽  
Peripheral Nerves ◽  
Nerve Conduction Velocity ◽  
Nerve Fibers ◽  
Nerve Graft ◽  
Nerve Conduit ◽  
Nerve Grafts ◽  
Facial Nerves

Objective: To evaluate the effects of amniotic extracellular matrix (AECM) on the repairation of facial nerve in rabbits. Methods: The transected nerve ends of the facial nerves of rabbits were then repaired with the AECM nerve conduit or an autologous nerve graft. After 3 months, the animals’ neural conductive velocity were determined. The myelinated fibers across the specimen were counted with histological examination. Results: The total count of medullated nerve fibers varied significantly, but the nerve conduction velocity had no significance between the AECM grafts and the autologous nerve grafts. Conclusion: AECM could become the biocompatible material for repairing the peripheral nerves.

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.

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