[Results of reinnervation after peripheral nerve repair by a microsurgical technique used in 1996-1998]. / Výsledky reinervace periferních nervu osetrených mikrochirurgickou technikou v letech 1996-1998.

PURPOSE OF THE STUDY: The authors present the results of a retrospective study of reinnervation after peripheal nerve repair by a microsurgical technique between 1996 and 1998. This is a development of a previous study by their colleagues. MATERIAL: Between 1996 and 1998, 113 injured peripheral nerves were treated by epineuroperineural suture (Ethilon; thickness, 8/0-10/0) under a microscope. To achieve a homogeneous group, 12 median and 13 ulnar nerves were included and evaluated in this retrospective study. All nerves studied were completely severed at the distal forearm and had sharply cut ends. METHODS: The results of reinnervation were retrospectively analyzed and classified according to the British Medical Research Council system (Seddon, 1972). The patients were followed up for 3 years. The patient's satisfaction with hand function was rated according our own classification. Tinel's sign and scar tenderness were evaluated. RESULTS: 17 patients (68%) achieved motor function M3 or higher and 16 patients (64%) had sensation S3 or higher. Better motor function was achieved after repair of the median than the ulnar nerve (M3 and higher in 91% and 46%, respectively). Better sensory recovery was achieved after repair of the ulnar than the median nerve (S3 and higher in 77% and 50%, respectively). Tinel's sign was positive in 68% of the patients; 10% of the patients complained of scar tenderness. DISCUSSION: Our results are comparable with the studies published so far. The patients with median nerve lesions showed better improvement after repair than those with ulnar nerve lesions and the outcome was better in hands with injury to only one nerve than in those with both nerves injured. The factors that influence peripheral reinnervation and the recovery of hand function are discussed. The surgical technique used, patient's age, regenerative capacity of the peripheral nerve affected, the interval between injury and the definitive microsurgical procedure and the quality of postoperative care are considered to be most important. CONCLUSIONS: Lesions of the peripheral nerve require special attention by a neurosurgeon competent to provide appropriate microsurgical treatment. The interval between injury and definitive treatment should be as short as possible. Postoperative care (rehabilitation and regular neurological examination) is also an important part of treatment.