Repair fingertip defect and soft tissue defect of donor site with nerve anastomosed relay flap / 中华显微外科杂志

Objective:To explore the method and effect of repairing fingertip defect and soft tissue defect in donor area by relay flap with suture nerve.Methods:From January 2017 to May 2019, 11 cases of fingertip defects were repaired with reverse island fascial pedicle flap of dorsal digital artery sutured with nerve, with a flap area of 0.6 cm×1.2 cm-1.6 cm×2.0 cm, and the flap donor area was repaired with dorsal metacarpal artery cutaneous branch flap. The patients were followed-up by outpatient, reexamination and WeChat interviews.Results:Twenty-two flaps of 11 cases survived completely and the wound healed in stage I. The postoperative follow-up ranged from 3 to 36 months, with an average of 13 months. The flap and pedicle were not bloated, the shape of finger was satisfactory, the texture was soft, and the skin color was close to the skin of finger. Sensory recovery≥S 3. The TPD of the flap was 6-11 mm, with an average of 8.4 mm. Hand function was evaluated according to the Trial Standard of Upper Limb Function Evaluation of Chinese Medical Association: excellent in 10 cases and good in 1 case. The patients were satisfied with the repair effect and resumed their daily life and work. Conclusion:This operation is simple, does not need to sacrifice the main blood vessels and nerves, can restore the good shape and sensction of the affected finger, with the activity close to normal. It is an effective method to repair the fingertip defect.

Effects of eliminating tension by means of epineural stitches: a comparative electrophysiological and histomorphometrical study using different suture techniques in an animal model / Avaliação dos efeitos da eliminação da tensão através de ancoramento epineural: estudo experimental comparando resultados eletrofisiológicos e histomorfométricos após diferentes técnicas de reparo no nervo

Epineural stitches are a means to avoid tension in a nerve suture. We evaluate this technique, relative to interposed grafts and simple neurorraphy, in a rat model. METHOD: Twenty rats were allocated to four groups. For Group 1, sectioning of the sciatic nerve was performed, a segment 4 mm long discarded, and epineural suture with distal anchoring stitches were placed resulting in slight tension neurorraphy. For Group 2, a simple neurorraphy was performed. For Group 3, a 4 mm long graft was employed and Group 4 served as control. Ninety days after, reoperation, latency of motor action potentials recording and axonal counts were performed. Inter-group comparison was done by means of ANOVA and the non-parametric Kruskal-Wallis test. RESULTS: The mean motor latency for the simple suture (2.27±0.77 ms) was lower than for the other two surgical groups, but lower than among controls (1.69±0.56 ms). Similar values were founding in both group 1 (2.66±0.71 ms) and group 3 (2.64±0.6 ms). When fibers diameters were compared a significant difference was identified between groups 2 and 3 (p=0.048). CONCLUSION: Good results can be obtained when suturing a nerve employ with epineural anchoring stitches. However, more studies are needed before extrapolating results to human nerve sutures.

A aproximação através de pontos epineurais é uma forma de se reduzir a tensão numa neurorrafia. Neste estudo esta técnica é avaliada através da sua comparação com a interposição de enxertos e neurorrafia simples num modelo experimental utilizando o rato. MÉTODO: Vinte ratos foram utilizados e divididos em 4 grupos. No Grupo 1, após a ressecção de 4 mm, os cotos do nervo foram aproximados através de pontos de ancoramento epineurais e suturados com tensão. No Grupo 2, uma neurorrafia simples foi realizada após secção do nervo. No Grupo 3, um enxerto de 4 mm foi utilizado para o reparo e o Grupo 4 foi utilizado como controle. Noventa dias após, os nervos foram novamente expostos e a medida da latência do potencial de ação motor e a contagem axonal foram realizados. A comparação entre os grupos foi realizada através da comparação entre as médias (ANOVA) e com o teste não-paramétrico de Kruskal-Wallis. RESULTADOS: A média da latência motora na sutura simples (2,27±0,77 ms) foi menor em relação aos outros dois grupos onde o nervo foi seccionado e reparado e maior que o grupo controle (1,69±0,56 ms). Resultados semelhantes foram identificados nos grupos 1 (2,66±0,71 ms) e 3 (2,64±0,6 ms). Uma diferença significativa diâmetros das fibras foi identificada quando comparados os grupos 2 e 3 (p=0,048). CONCLUSÃO: Resultados equiparáveis aos obtidos com enxerto podem ser obtidos quando a neurorrafia é realizada com pontos epineurais de ancoramento com tensão, mas estudos adicionais são necessários antes desses resultados serem extrapolados para o reparo de nervo em seres humanos.

Efectos de la eliminación de la tensión mediante puntos epineurales: estudio comparativo empleando diferentes técnicas de sutura en un modelo animal / Effects of tension elimination by using epineural anchoring stitches: a comparative study employing different techniques of suture in an experimental model

Objetivo. Documentar la utilidad de una técnica de sutura epineural bajo tensión, en comparación con la sutura mediante injerto interpuesto y la neurorrafia termino-terminal, en un estudio realizado en un modelo experimental animal (rata Wistar). Material y Método. Un lote de 20 animales, considerados como 40 unidades fisiológicas independientes a nivel del miembro inferior, fueron separados en 4 grupos de 10: en el primero se realizó una sutura bajo tensión con puntos epineurales a nivel del nervio ciático luego de resecar 4 mm de nervio. En el segundo se realizó una sutura término-terminal sin tensión, en el tercero se colocó un puente de injerto autólogo de 4 mm de extensión y el cuarto fue utilizado como control. A los 90 días de efectuados los procedimientos, se reexpusieron las zonas operadas y se documentaron las respuestas fisiológicas a los diferentes tipos de sutura mediante potenciales de acción de músculo (PAM) y nervio (PAN). Resultados. El promedio de la velocidad de conducción para la sutura simple fue el mejor de los tres grupos operados (14,60 mm/ ms), aunque peor que el control (19,31 mm/ms). La sutura a tensión mediante puntos epineurales (12,02 mm/ms) demostró resultados neurofisiológicos superiores que cuando se utilizó injerto autólogo (11,09 mm/ms). Conclusión. El presente estudio demuestra que si se logra coaptar un nervio ciático de rata mediante sutura epineural con puntos distales a la línea de neurorrafia, sus resultados son mejores que al emplear injerto. Sin embargo, estos resultados, obtenidos en un modelo de animal pequeño, deben ser cuidadosamente extrapolados a la práctica quirúrgica habitual.

Objective. To measure the utility of this technique, in comparison with interposed grafts and termino-terminal neuroraphy, all applied in an experimental model (Wistar rat).Materials and method. 20 rats were used in both sides (40 legs, each one considered as independent physiological units, were grouped in four groups: in the first one, a section of thesciatic nerve was performed, a segment 4mm long was discarded and an epineural suture with distal anchoring stitches was done under slight tension. In the second group a tensionlesstermino-terminal neuroraphy was performed after sciatic nerve section. In the third group a 4 mm long graft was employed and the fourth was used as control. 90 days after this procedure, the animals were reoperated and muscle and nerve action potentialswere recorded in both sides. Results. The mean conduction velocity for the simple suture was higher than the other two groups, but lower than the control(19,31 mm/ms). Neuroraphy with epineural stitches (12,02 mm/ms) was better than when an autologous nerve graft was employed (11,09 mm/ms).Conclusion. This study demonstrates that a good result can be obtained if a nerve is sutured under slight tension, employing epineural anchoring stitches. Nevertheless, more studies shouldbe performed before applying these results to human nerve suture.