Proposal of a New Classification of Nerve Lesions
Bruno Battiston, MD, PhD, UO di Microshirurgia Ricostruttiva, Hand Surg., Microsurg. Unit, Torino, Italy, Paolo Titolo, MD; Stefano Artiaco, MD; Francesco Giacalone, MD
UO di Microshirurgia Ricostruttiva, Hand Surg., Microsurg. Unit, Torino, Italy
Nowadays, surgical resolution of a disability resulting from a peripheral nerve lesion is no longer an impossible task for the surgeon even if a correct understanding of the lesion is essential to choose the appropriate surgical treatment, its timing and the rehabilitation program.
Many papers presenting the outcome of nerve repairs start with imprecise classification of the lesion and the results may be different if the repair face a crush or a neat lesion, a proximal or a distal one.
We propose a classification which in a simple way may help in the task of grouping similar lesions facilitating then the transmission of data and their collection for the final presentation.
The lesion is presented through a series of letters and numbers which represent the involved nerve and its composition, the level and type of the lesion.
The nerve is presented with its initials : A=Axillary, S=Suprascapular, LT=LongThoracic, TD=ToracoDorsal, Mu=Musculocutaneous, Me=Median, R=Radial, S= Sciatic, P=Peroneal, T=Tibial . The site of the lesion is then charactarized by a number : 1=Shoulder/Pelvis; 2= Arm/Thigh; 3= Elbow/Knee; 4= Forearm/Leg; 5=Wrist-Hand / Ankle-Foot. The composition of the nerve at the level of the lesion is again expressed by a number : 1=Motor, 2=Sensory, 3= Mixed. A simple letter describes if it is an open or closed injury ( O or C ). The characteristics of the nerve lesion are then represented in the following way : P= Partial/InContinuity; C=Complete (1 Neat - 2 Crushed - 3 Loss of tissue).
Then, the string U43OC.1 means a lesion of the ulnar nerve at wrist level when it is still mixed . The injury is an open one, complete and neat.
We used this system in 40 cases of two different centers making easy the data transmission and classsification.
Additional letters and numbers may be useful in the evaluation of the surgery and the factors influencing the final result : Age : A= Aged (more than 60); B=Young ; Timing : 1= Immediate; 2= Delayed; 3= Secondary ; Technique : 1 = Suture; 2 = Graft up to 10 cm ; 3= Graft more than 10 cm. ; Comorbidity (smoke, diabete, etc.) : Y=Yes ; N=No
We aim to present the rationale and the technical details of this new classification discussing its utility and limits.
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