Arched nerves of double end-to-side neuroanastomosis for repairing bilateral acute proper digital nerve injuries / 第二军医大学学报

ABSTRACT

Objective To explore a new method for repairing bilateral acute proper digital nerve injuries. Methods From Feb. 2009 to Aug. 2012, 56 patients with bilateral acute proper digital nerve injuries were admitted to our center, with20 undergoing double end-to-side neuroanastomosis. During operation, the injured digital nerve was excised, and then the bilateral distal ends and proximal endswere stured, consequently forming the distal and proximal nerve bows. A cutaneous antebrachii lateralis nerve was freed and obtained from the homolateral forearm, and then was equally divided into 2 parts to bridge the 2 nerve bows. Twenty patients underwent nerve graft with end-to-end neuroanastomosis, and the rest 16 patients underwent direct end-to-end neuroanastomosis. Results All the patients achieved primary healing of wound after operation, with no circulation disorders. A total of 50 patientswere followed up for 3-12 months. In double end-to-side neuroanastomosis group, 18 patientswere successfully followed up, with the average sensation measurement being S3+, which was significantly higher than those of the other 2 groups(P = 0. 024). The average result of two point discrimination was (5. 2±0. 7) mm, which was significantly lower than those of the other 2 groups(P = 0. 037). According to TAM scales, the results of finger joint motion were excellent in 14 cases, good in 3 cases and fair in 1; and there were no significant differences in the motion of joints between the 3 groups (P = 0. 914). In nerve graft with end-to-end neuroanastomosis group, 19 patients were successfully followed up; the average result of sensation measurement was S2 and the average result of two point discrimination was (7. 2±1. 4) mm. In direct end-to-end neuroanastomosis group, 13 patients were successfully followed up; the average result of sensation measurement was S3 and the average result of two point discrimination was (6. 3±0. 8) mm. Conclusion The arched nerves of double end-to-side neuroanastomosis can be used for repairing bilateral acute proper digital nerve injuries, which can quickly restore the sensation of fingers, but the related conclusion needs further verification with large sample studies.