End-to-side neurorrhaphy in peripheral nerves: Does it work?

Acute peripheral nerve injuries are common and can cause physical disabilities with sensory and functional sequelae; they therefore require surgery. The aim of this study was to conduct a systematic review to assess the clinical applicability of end-to-side neurorrhaphy in peripheral nerve reconstruction, based on available evidence. We carried out a systematic review of the literature using MEDLINE/PubMed, EMBASE, Cochrane Library, Web of Science, Scielo and Scopus through March 16, 2021. Most of the selected studies were qualitative and employed nonrandomized groups of patients, without standardized scales for assessing outcomes, which made statistical analysis difficult. Efficacy varied from 24% to 81%. Factors for better outcome included the type of injury, type of injured nerve (sensory, motor or mixed), presence of an epineural window, topography, injury extension <1.3 cm, and intervention within 2 weeks of injury. Clinical studies so far lack scientific evidence on end-to-side neurorrhaphy in peripheral nerve lesions.

Comparison of nerve conduits and nerve graft in digital nerve regeneration: A systematic review and meta-analysis.

The goal of this systematic review and meta-analysis was to compare nerve conduits and nerve graft for peripheral nerve regeneration. This type of lesion frequently causes disability due to pain, paresthesia and motor deficit. On the PICO process, "P" corresponded to patients with peripheral digital nerve lesions of any age, gender or ethnicity, "I" to interventions with nerve conduits or nerve graft, "C" to the control group with no treatment, placebo or receiving other treatment, and "O" to outcome assessment of nerve regeneration. Initial search found in 3859 studies, including 2001 duplicates. The remaining 1858 studies were selected by title and/or abstract; 1798 articles were excluded, leaving 60 articles for full-text review. Thirty-nine of these 60 reports were excluded as not meeting our inclusion criteria, and 21 articles were ultimately included in the systematic review. For patients older than 40 years, there was a greater mean improvement on S2PD and M2PD tests with grafting, which seemed to be the better surgical technique, positively impacting prognosis. On the M2PD test, there was significantly greater improvement in 11-17.99 mm defects with grafting (P < 0.001); this finding should guide surgical strategy in peripheral nerve regeneration, to ensure better outcomes.

Nerve conduits for treating peripheral nerve injuries: A systematic literature review.

Peripheral nerve injuries are a major public health problem. Nerve conduits have been developed in the recent years, although it is still not clear if they should replace nerve grafting and neurorrhaphy. This systematic review aims to gather evidence regarding the use of nerve conduits for peripheral nerve repair. The following electronic databases were searched: MEDLINE, Cochrane Library (CENTRAL) and Embase. Study selection and data extraction followed the PRISMA guidelines. The systematic review of the literature retrieved 6767 articles. Only 27 studies were retained accounting for 1022 patients: 10 randomized controlled trials, 15 case series and 2 cohort studies. Ten different types of tubes were described and a variety of evaluation methods were used to assess outcomes in terms of efficacy (motor and sensory recovery) and complications. The Semmes-Weinstein monofilament test and the static and moving 2-point discrimination test were the most commonly applied tests to evaluate nerve recovery. In general, outcomes showed no significant difference between groups. Synthetic conduits had more complications. Despite major methodological limitations in the studies, we can conclude that use of nerve conduits is preferable over suture repair and nerve grafting, as the functional recovery rates are above 80%. The choice of conduit is based on the surgeon's expertise, but use of synthetic conduits is discouraged due to their higher complication rates.

A comparison of the use of distal radius vascularised bone graft and non-vascularised iliac crest bone graft in the treatment of non-union of scaphoid fractures.

We compared two surgical techniques for the treatment of scaphoid non-union, namely, using distal radius vascularised bone graft and iliac crest non-vascularised bone graft. Eighty patients with symptomatic scaphoid non-union underwent surgical treatment, including 35 patients treated with distal radius vascularised bone graft and 45 treated by iliac crest non-vascularised bone graft. Patients were assessed objectively by examination of wrist range of motion, grip strength and radiographic findings in the postoperative period after a mean time of 2.8 (1.4) (range 1-5.2) years. Similar functional results were obtained with the two techniques. All cases of non-union in the non-vascularised group obtained consolidation in a mean time of 8.89 (2.26) months and in the vascularised group in a mean time of 7.97 (3.06) months. Three cases of consolidation failure occurred in the vascularised group and were related to technical difficulties.

Can local supply of bone marrow mononuclear cells improve the outcome from late tubular repair of human median and ulnar nerves?

The purpose of this non-randomised retrospective study was to compare nerve regeneration after reconnection with silicone tubes with two different strategies. A total of 44 patients with injured median or ulnar nerves in the forearm were surgically treated. In one group of patients, a silicone tube alone was placed in the nerve gap. In a second group, the silicone tube was filled with autologous bone marrow mononuclear cells obtained by aspiration from the iliac crest. Motor function, sensation and the effect of pain on function were assessed 1 year after surgery. The tubes filled with bone marrow cells showed better recovery than the empty tubes. The use of bone marrow mononuclear cells in addition to tube re-connection may promote better nerve regeneration than conventional tubular repair.

[The treatment of digital nerve defects by the technique of vein conduit with nerve segment. A randomized prospective study]. / La reparation de pertes de substance des nerves digitaux avec la technique de la greffe veineuse plus interposition de tissu nerveux. Etude prospective et randomisée.

OBJECTIVE: This study aims to compare the results of treating digital nerve defects with autologous sural nerve grafts as compared to using a vein conduit with interposition of a posterior interosseous nerve segment. METHODS: This study is a clinical, prospective, randomized and blinded trial, comparing digital nerve defects treated by two different surgical techniques. It included a total of 50 digital nerves (25 patients in each treatment group), with a mean follow up of 10.2 (SD 1.4) months. In addition, the impact of five different factors (type of surgery, size of nerve defect, patient's age, type of lesion and lesion age) on the final outcome were evaluated. RESULTS: In respect of the sensory assessment, the static two point discrimination score was 6 mm for both groups . According to the Al-Ghazal Scoring Method, the autolougus sural nerve graft group scored a mean (sd) of 7.7 (1.9) points, while vein conduit with interposition of a posterior interosseous nerve segment group scored 6.9 (2.1). Under multivariate analysis, both patient's age and lesion age proved to be important independent factors, having influenced almost all results. The group treated with vein conduit with interposition of a posterior interosseous nerve segments showed fewer complications than the group treated using sural nerve. CONCLUSION: Based on the results obtained, we concluded that the sensory scores were equal in both groups. We also concluded that the vein conduit and posterior interosseous nerve graft procedure offered some advantages in terms of the complication rate.

Shoulder strength profile in elite junior tennis players: horizontal adduction and abduction isokinetic evaluation.

OBJECTIVE: To establish normative data for muscle performance during isokinetic horizontal abduction and adduction of the shoulder in elite junior tennis players. METHODS: Thirty six tennis players were evaluated (23 male, 13 female; mean age 14 years (range 12-18)). An isokinetic dynamometer was used to test the shoulder horizontal abductors and adductors at 60 and 180 degrees/s. Absolute and relative peak torque (PT and PT/BW), total work (TW), endurance ratio (ER), and the ratio of the peak torque between horizontal abductors and adductors (HAB/HAD ratio) were recorded. Data were compared for the dominant and non-dominant shoulders, horizontal abductor and adductor muscles, and between players grouped according to age. RESULTS: The dominant shoulder was significantly (p<0.05) stronger than the non-dominant shoulder in all variables except ER and HAB/HAD ratio. The abductors were significantly (p<0.05) weaker than the adductors in all subjects. The type of backhand (one handed or two handed) did not influence the strength of the shoulder horizontal abductors on the dominant side. The number of years of tennis practice had an effect on muscle strength as evaluated by absolute data (PT and TW) but not relative measurements (PT/BW and TW/BW). CONCLUSION: The findings confirm that horizontal abduction and adduction are stronger in the dominant shoulder of junior tennis players. The clinical relevance of these findings is not established, and more studies are needed to compare tennis players with athletes from other sports and non-athletes.

Early active mobilization after flexor tendon repairs in zone two.

INTRODUCTION: This study aims to evaluate an early mobilization regimen after 136 flexor tendon repairs in zone two in 82 patients. METHOD: Postoperatively patients were managed by an early mobilization program, which incorporated immediate active flexion and extension. Results are based on both the International Federation of Societies for Surgery of the Hand (IFSSH) and the Strickland systems of evaluation. The results of long fingers and thumbs were analyzed separately. RESULTS: The results of the long fingers group were excellent (72.2%), good (26.0%) and fair (1.9%) according to Strickland's standards and were good (81.5%), fair (16.6%) and poor (1.9%) according to the IFSSH standards. The results of the thumbs group were excellent (96.4%) and fair (3.6%) according to Strickland's standards and were excellent (82.1%), good (14.3%) and poor (3.6%) according to the IFSSH standards. CONCLUSION: This study corroborates evidence that postoperative programs that incorporate early active flexion can produce good results after flexor tendon repair in zone two.

[Mandibular reconstruction: conduct of osseous integrated implants of iliac crest and fibula free laps]. / Reconstruction mandibulaire: les lambeaux microchirurgicaux de crête iliaque et péroné.

Reconstruction of the mandible osseous defects following radical ablation is usually carried out by means of vascularized f. Plapsossible donor sites often include fibula, radius, scapula and iliac crest. In the present report, we raise our experience of 45 cases of osseous reconstruction of the mandible utilizing the iliac crest (35 patients) and the fibula (10 patients). Patients were selected to this study based on the presence of purely osseous defects and evaluated functionally after the inclusion the osseous integrated implants.

An anatomical study of the dorsal cutaneous branches of the digital arteries.

This study describes the anatomy of the dorsal digital arteries in the 144 fingers of 18 pairs of fresh human cadaver hands. Previous studies have shown two constant branches in the proximal and middle pulp spaces from each proper digital artery. We have shown that these branches have consistent sites of origin at predictable distances from the proximal interphalangeal joint. Thus cutaneous flaps can be safely planned on these dorsal vessels.

[Single digit replantations in ambulatory surgery. 85 cases]. / Les réimplantations unidigitales en ambulatoire. A propos de 85 cas cliniques.

The author performed 85 ambulatory digital replantations between 1994 and 1999. Ages varied from 15 to 33 (average 24), with a prevalence of the male sex. The main mechanism of injury was guillotine (60%), followed by avulsion (40%). Surgical procedure lasted approximately four hours. Patients remained in the hospital for eight hours maximum, period in which they were closely observed. Patients received printed instructions about the risks of arterial and venous thrombosis and how they could observe it themselves. A protocol was established to evaluate the results. Patients were instructed to call the surgeon as soon as any change--mainly in color--was noticed. Based on a phone call, twenty patients were evaluated in the immediate postoperative period (24 initial hours) to rule out circulatory problems. In fifteen patients, thrombosis was noted in the replanted segment. Twelve of these patients (14.11%) lost the replanted digit completely. The loss of the replanted segment was not observed in the group of patients that did not call the surgeon.

The innervation of the proximal interphalangeal joint and its application in neurectomy.

In an anatomic study of 64 fingers, we demonstrated that the proximal interphalangeal joint is innervated by branches of the palmar digital nerves. The number of articular branches ranges from two to four and their origins from the digital nerve are between 2 and 8 mm from the proximal interphalangeal joint. In a clinical series of 24 neurectomies in 21 patients, there was a significant improvement in pain and range of motion in 22 fingers. We conclude that neurectomy is a therapeutic option in the treatment of osteoarthritis of the proximal, interphalangeal joint.

Repositioning and flap placement in fingertip injuries.

After finger amputations, replantation is often the best option of treatment. However, microvascular repair may not be feasible for more distal amputations. Reposition of the amputated segment associated with a local flap can provide length, sensation, and bulk. This is especially useful in distal-to-distal interphalangeal joint fingertip amputations. From 1994 to 1998, 30 reposition and flap procedures were performed by the authors. In 28 cases, the homodigital unipedicle island flap was used and in two cases the Tranquilli-Leali flap was used. Patients were observed for 24 months to evaluate joint mobility, nail aesthetics and function, as well as sensitivity. Mobility was considered satisfactory in all repositioned segments except two, in which a 20-deg extension deficit at the proximal interphalangeal joint was noticed. Digit length was approximately the same in relation to the opposite side, and the nail did not change markedly from case to case. Two-point discrimination ranged from 7 to 9 mm. Intolerance to cold was observed in 7 patients. Reposition associated with a local flap has been a good surgical alternative for more distal amputations because it preserves digit length and sensitive digital pinch.

The use of silicone tubing in the late repair of the median and ulnar nerves in the forearm.

A silicone tube segment was used for repairing the median and ulnar nerves in the forearm. This study includes 26 patients (20 male and six female), with a mean age of 23 years (range, 18-26). Injuries were caused by saw, knife and glass accidents, the latter being most frequent. The mean interval between the injury and repair was 101 days. Fourteen patients had median nerve injuries, eight had ulnar nerve injuries and four had both median and ulnar nerve injuries. The technique was effective in the repair of peripheral nerve injuries with gaps of up to 3 cm, with better results in the ulnar nerves than in the median nerves.