scholarly journals Reconstruction of a long defect of the median nerve with a free nerve conduit flap

2020 ◽  
Vol 47 (2) ◽  
pp. 187-193 ◽  
Author(s):  
Andrea Campodonico ◽  
Pier Paolo Pangrazi ◽  
Francesco De Francesco ◽  
Michele Riccio
Keyword(s):  
Peripheral Nerve ◽  
Median Nerve ◽  
Upper Limb ◽  
Muscle Power ◽  
Functional Performance ◽  
Nerve Repair ◽  
Traumatic Injury ◽  
Rehabilitation Program ◽  
Tissue Loss ◽  
Soft Tissue Loss

Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may be limited following peripheral nerve repair in cases of delayed reconstruction or reconstruction of long nerve defects. A 26-year-old man presented with traumatic injury from a wide, blunt wound of the right forearm caused by broken glass, with soft tissue loss, complete transection of the radial and ulnar arteries, and a large median nerve gap. The patient underwent debridement and subsequent surgery with a microsurgical free radial fasciocutaneous flap to provide a direct blood supply to the hand; the cephalic vein within the flap was employed as a venous vascularized chamber to wrap the sural nerve graft and to repair the wide gap (14 cm) in the median nerve. During the postoperative period, the patient followed an intensive rehabilitation program and was monitored for functional performance over 5 years of follow-up. Our assessment demonstrated skin tropism and sufficient muscle power to act against strong resistance (M5) in the muscles previously affected by paralysis, as well as a good localization of stimuli in the median nerve region and an imperfect recovery of two-point discrimination (S3+). We propose a novel and efficient procedure to repair >10-cm peripheral nerve gap injuries related to upper limb trauma.

scholarly journals The pedicled thoraco-umbilical flap: A versatile technique for upper limb coverage

2009 ◽  
Vol 42 (02) ◽  
pp. 169-175 ◽  
Author(s):  
Sharad Mishra ◽  
Ramesh Kumar Sharma
Keyword(s):  
Upper Limb ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Flap Necrosis ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery ◽  
Versatile Technique ◽  
Soft Tissue Loss ◽  
Flap Cover

ABSTRACTInjuries to upper limb has been on the increase and is invariably associated with significant soft tissue loss requiring a flap cover. Local tissue may not be available for cover in a majority of situations, necessitating import of tissue from a distant source. We have utilized the thoraco-umbilical flap taken from the trunk for this purpose. This flap is based on the perforators of the deep inferior epigastric artery that are maximally centred on the periumbilical region. This flap was used in 83 patients. The patients were observed for at least 3 weeks and any flap or donor site complications were recorded. The patients were again followed up at 3 months interval and the donor site scar was assessed. The flaps survived in 81 patients; there was marginal flap necrosis in five patients and partial flap necrosis in two patients. None of these patients required any additional procedure for coverage. The flap is technically easy to plan, almost effortless to drape around upper limb defects, with no significant donor site morbidity and also the post operative immobilization was fairly comfortable. The thoraco-umbilical flap thus is a very useful technique for coverage of the upper limb and is recommended as a first line flap for this purpose.

scholarly journals Bioengineered nerve conduits and wraps for peripheral nerve repair of the upper limb

2017 ◽  
Author(s):  
Suzanne E Thomson ◽  
Nigel YB Ng ◽  
Mathis O Riehle ◽  
Paul J Kingham ◽  
Lars B Dahlin ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Upper Limb ◽  
Nerve Repair ◽  
Peripheral Nerve Repair ◽  
Nerve Conduits

Nerve transfers for peripheral nerve injury in the upper limb

2019 ◽  
Vol 101-B (2) ◽  
pp. 124-131 ◽  
Author(s):  
J. Isaacs ◽  
A. R. Cochran
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Upper Limb ◽  
Nerve Repair ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Axillary Nerve ◽  
Nerve Transfers ◽  
Sensory Recovery ◽  
Potential Benefits

Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based discussion explores the principles and potential benefits of nerve transfer surgery and offers in-depth discussion of several established and valuable techniques including: motor transfer for elbow flexion after musculocutaneous nerve injury, deltoid reanimation for axillary nerve palsy, intrinsic re-innervation following proximal ulnar nerve repair, and critical sensory recovery despite non-reconstructable median nerve lesions.

scholarly journals Epidemiological Study of 1368 Cases of Surgical Repair for Traumatic Peripheral Nerve Injury.

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Ridvan Alimehmeti ◽  
Gramoz Brace ◽  
Ermira Pajaj ◽  
Alda Kika ◽  
Jetmira Kerxhalliu ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Ad Hoc ◽  
Nerve Repair ◽  
Traumatic Injury ◽  
Epidemiological Data ◽  
Effector Organ ◽  
Clinical Records ◽  
Gender Type

Traumatic injury of the peripheral nerves should be treated in specialized centres. This study presents the epidemiological data of 1368 consecutive patients operated for peripheral nerve injuries beside the Service of neurosurgery, Department of Neurosciences, UHC "Mother Theresa", Tirana. In order to obtain the necessary data for this study we revised the clinical records, surgical registers and pre, intra and postoperative photo/video of the cases operated for peripheral nervous system injuries. A data recording program of the surgery cases was built ad hoc, categorizing the cases according to several variables. The data collected from the operated cases were manually inserted to be processed by the program. Results of informatics elaboration of the data were obtained, reviewed and categorized by: age, gender, type of trauma, localization of injury and type of nerve repair. Future studies to be conducted in this field will focus in determining the level of nerve injury, time from the injury to intervention, distance from the site of trauma to the effector organ. The data will build necessary information for data mining, which based on these important factors that influence the result of nerve repair, will be useful for the prediction of the result in new patients harbouring peripheral nerve injury before undergoing surgery.

A review of 10 years of scapula injuries sustained by UK military personnel on operations

2017 ◽  
Vol 164 (1) ◽  
pp. 30-34 ◽  
Author(s):  
Darren C Roberts ◽  
D M Power ◽  
S A Stapley
Keyword(s):  
Soft Tissue ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Military Personnel ◽  
High Energy ◽  
Tissue Loss ◽  
Multiple Injuries ◽  
Severity Scores ◽  
Soft Tissue Loss ◽  
Scapula Fractures

BackgroundScapula fractures are relatively uncommon injuries, mostly occurring due to the effects of high-energy trauma. Rates of scapula fractures are unknown in the military setting. The aim of this study is to analyse the incidence, aetiology, associated injuries, treatment and complications of these fractures occurring in deployed military personnel.MethodsAll UK military personnel returning with upper limb injuries from Afghanistan and Iraq were retrospectively reviewed using the Royal Centre for Defence Medicine database and case notes (2004–2014).ResultsForty-four scapula fractures out of 572 upper limb fractures (7.7%) were sustained over 10 years. Blast and gunshot wounds (GSW) were leading causative factors in 85%. Over half were open fractures (54%), with open blast fractures often having significant bone and soft tissue loss requiring extensive reconstruction. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores (ISS) were significantly higher than the average upper limb injury without a scapula fracture (p<0.0001). Brachial plexus injuries occurred in 17%. While military personnel with GSW have a favourable chance of nerve recovery, 75% of brachial plexus injuries that are associated with blast have poorer outcomes. Fixation occurred with either glenoid fractures or floating shoulders (10%); these were as a result of high velocity GSW or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all scapula fractures united.ConclusionScapula fractures have a 20 times higher incidence in military personnel compared with the civilian population, occurring predominantly as a result of blast and GSW, and a higher than average ISS. These fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss.

The Epidemiology and Management of Upper Limb Peripheral Nerve Injuries in Modern Practice

1996 ◽  
Vol 21 (1) ◽  
pp. 4-13 ◽  
Author(s):  
R. M. R. McALLISTER ◽  
S. E. A. GILBERT ◽  
J. S. CALDER ◽  
P. J. SMITH
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Upper Limb ◽  
Primary Repair ◽  
Nerve Repair ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Frequency Distributions ◽  
South East England ◽  
Delayed Referral

This paper reports an epidemiological and clinical study of 813 patients with 1,111 peripheral nerve injuries who were treated for upper limb trauma, which included nerve injury, at two plastic surgery units in south-east England, predominantly between the years 1982 and 1991. The frequency distributions of the levels of nerve injury, and the causes of nerve injury in the sample, are presented, together with the surgical management and timing of nerve repair in these patients. 1,018 clinically suspected nerve injuries in 730 patients (91.6% of nerves, 89.8% of patients) were treated by primary nerve repair, elective delayed nerve repair or primary surgical exploration alone. Divisions of 93 nerves in 83 patients (8.3% of nerves, 10.2% of patients) were treated other than by primary repair or elective delayed repair, due to delayed referral from accident and emergency departments, resulting from missed or uncertain diagnosis at presentation or otherwise unaccounted delay in the initial referral.

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

Congenital peripheral nerve hypoplasia: a report of seven cases

2020 ◽  
Vol 45 (10) ◽  
pp. 1028-1033
Author(s):  
Xiaofei Tian ◽  
Wee Leon Lam ◽  
Wen Guo ◽  
Tao Chen ◽  
Shanlin Chen
Keyword(s):  
Peripheral Nerve ◽  
Median Nerve ◽  
Upper Limb ◽  
Clinical Findings ◽  
Mechanical Compression ◽  
Level Of Evidence ◽  
Contralateral Limb ◽  
Median Nerve Palsy ◽  
Mean Diameter ◽  
The Mean

We report the clinical findings of congenital peripheral nerve hypoplasia in seven patients. All seven children presented with unilateral ulnar or median nerve palsy or both. They were assessed clinically, and nerve diameters were assessed with ultrasonography and compared with the contralateral limb. Nerve conduction studies were performed in five children, and the nerves were explored in the four children who presented with accompanying constriction bands. By ultrasonography, the mean diameter of the ulnar nerve was 63% and 29% when compared with the normal arm and forearm, respectively, and the mean diameter of the median nerve was 63% and 46%. Hypoplasia in the nerve was not confined to constriction points but occurred in the entire upper limb in all seven cases. These patients were followed for an average of 12 months (range 6 to 30). Despite neurolysis and surgical decompression in four patients, none of the nerve palsies had recovered. The clinical findings suggest that this condition cannot be explained by simple mechanical compression, and more extensive pathological changes in the involved upper limb are evident in this rare disease. Level of evidence: IV

Sign in / Sign up

Export Citation Format

Share Document