Nerve Repair By Fresh Muscle-Vein-Combined Guides: Surgical Technique And Actual Indications
Pierluigi Tos, MD, PhD; Bruno Battiston, MD, PhD, UOC
Hand Surgery, Turin, Italy
Introduction: Although autogenous nerve grafting is still considered the best method for bridging nerve defects, several alternative types of conduits (biological and synthetic) have been studied. We have demonstrated in previous experimental research that a graft made using a vein (providing a guide for nerve regeneration) filled with fresh skeletal muscle (to prevent vein collapse and support axon regeneration), gave similar results to traditional nerve grafts, in the rat. On this basis, we decided to use the muscle-vein-combined grafts in clinical cases not only for sensory nerves but also for mixed nerves in emergency. Despite continuous researches and surgical innovations, the treatment of peripheral nerve injuries remains a complex problem particularly in non sharp lesions where this kind of reconstruction is a good option of treatment. We report our case series and results.
Matherial and Methods: We present a series on 16 cases operated in emergency with blount lesions (8 sensory and 8 mixied nerves) that are considered the . We evaluated our results by the criteria of the Nerve Injuries Committee of the BMRC modified by Mackinnon-Dellon. We classified the results in three groups Very Good: >M4 / >S3+; Good: M3 / S3-S2+; Poor: < M2 / < S2+.
Results: We report good results in sensory nerves in 100% of cases; in 50% of mixed nerve we report good resultrs.
Conclusions: The clinical employment of tubes as an alternative to autogenous nerve grafts is mainly justified by the limited availability of donor tissue for nerve autograft and its related morbidity. Indication are very restricted : treatment in emergency , not enough nerve graft, no will of the patient on harvesting a healthy nerve.
Our retrospective study demonstrated that favourable results can be achieved either for primary repair of crush injured nerves when a short gap is present or in secondary procedures mainly for sensory nerves. An attempt of reconstruction in emergency with muscle-vein combined graft or alternative conduits is justified considering the possible advantages offered by this kind of nerve repair. Actual indications and the surgical technique will be reported.
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