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Nerve Grafting (nerve + grafting)

Distribution by Scientific Domains

Medical Sciences	80%

Selected Abstracts

Total obstetric brachial plexus palsy: Results and strategy of microsurgical reconstruction

MICROSURGERY, Issue 3 2010
Tarek A. El-gammal M.D.
From 2000 to 2006, 35 infants with total obstetric brachial plexus palsy underwent brachial plexus exploration and reconstruction. The mean age at surgery was 10.8 months (range 3,60 months), and the median age was 8 months. All infants were followed for at least 2.5 years (range 2.5,7.3 years) with an average follow-up of 4.2 years. Assessment was performed using the Toronto Active Movement scale. Surgical procedures included neurolysis, neuroma excision and interposition nerve grafting and neurotization, using spinal accessory nerve, intercostals and contralateral C7 root. Satisfactory recovery was obtained in 37.1% of cases for shoulder abduction; 54.3% for shoulder external rotation; 75.1% for elbow flexion; 77.1% for elbow extension; 61.1% for finger flexion, 31.4% for wrist extension and 45.8% for fingers extension. Using the Raimondi score, 18 cases (53%) achieved a score of three or more (functional hand). The mean Raimondi score significantly improved postoperatively as compared to the preoperative mean: 2.73 versus 1, and showed negative significant correlation with age at surgery. In total, obstetrical brachial plexus palsy, early intervention is recommended. Intercostal neurotization is preferred for restoration of elbow flexion. Tendon transfer may be required to improve external rotation in selected cases. Apparently, intact C8 and T1 roots should be left alone if the patient has partial hand recovery, no Horner syndrome, and was operated early (3- or 4-months old). Apparently, intact nonfunctioning lower roots with no response to electrical stimulation, especially in the presence of Horner syndrome, should be neurotized with the best available intraplexal donor. © 2010 Wiley-Liss, Inc. Microsurgery, 2010. [source]

End-to-side nerve grafting of the tibial nerve to bridge a neuroma-in-continuity

MICROSURGERY, Issue 2 2007
James M. Kerns Ph.D.
[source]

Outcomes of static and dynamic facial nerve repair in head and neck cancer

THE LARYNGOSCOPE, Issue 3 2010
Tim A. Iseli MBBS
Abstract Objectives/Hypothesis: Determine outcomes associated with nerve grafting versus static repair following facial nerve resection. Study Design: Retrospective chart review. Methods: Charts from 105 patients who underwent facial nerve reconstruction between January 1999 and January 2009 were reviewed. The majority had parotid malignancy (78.1%), most commonly squamous cell carcinoma (50.5%). Patients underwent static (n = 72) or dynamic (n = 33) reconstruction with nerve grafting. Facial nerve function was measured using the House-Brackmann (H-B) scale. Results: Patients receiving static reconstruction were on average 10.3 years older (P = .002). Mean overall survival for tumor cases was 61.9 months; parotid squamous cell carcinoma was associated with worse prognosis (P = .10). Median follow-up was 16.1 months (range, 4,96.1 months). Most (97%) patients receiving a nerve graft had some return of function at a median of 6.2 months postoperatively (range, 4,9 months) and the majority (63.6%) had good function (H-B score ,4). Patients having static reconstruction (29.2%) were more likely to have symptomatic facial palsy than those having a nerve graft (15.2%, P = .12). Conclusions: Where possible, nerve grafting is the preferred method of facial nerve reconstruction. Although elderly patients with parotid malignancy have traditionally been considered poor candidates for nerve grafting, we demonstrate good results within 9 months of facial nerve repair even with radiotherapy, the use of long grafts (>6 cm), and prolonged preoperative dysfunction. Laryngoscope, 2010 [source]

HS09 REPLANTATION SURGERY , THE RECONSTRUCTIVE APPROACH

ANZ JOURNAL OF SURGERY, Issue 2007
L. C. Teoh
The function of the replanted parts can be improved if attention to reconstruction techniques is carried out. These reconstructive techniques are: 1) adequate debridement and shortening, 2) stable skeletal fixation, 3) strengthened tendon repairs, 4) quality nerve repair, 5) extensive vascular anastomosis, 6) complete skin coverable, and 7) Early intensive active rehabilitation. 1) The debridement should be generous and the shortening judicious. More than 50% of the skin should be in direct contact, and direct anastomosis of some of vessels should be possible. 2) The skeletal stabilization should be of good very quality that will allow free mobilization of the joints. 3) The repair of the tendons should take advantage of the excess length for a strengthen repair. Some degree of active mobilization should be make possible. 4) Primary nerve grafting or nerve transfer should be considered if there is loss of nerve length. 5) Vascular repair should be on the basis of as many as possible the number of arteries and veins that can be found for anastomosis. 6) Any residual skin defect should be planned for a proper resurfacing within the next 5 to 10 days. 7) Early intensive active rehabilitation should be prescribed. Gradual active ROM for tendon gliding should be instituted with in the first week. The function of the replanted digit and hand has continued to improve with the reconstructive approach. With further experience the reconstructive approach can be done in all cases with confidence. [source]

Anatomical variations of the sural nerve

CLINICAL ANATOMY, Issue 4 2002
Pasuk Mahakkanukrauh
Abstract An anatomical study of the formation of the sural nerve (SN) was carried out on 76 Thai cadavers. The results revealed that 67.1% of the SNs were formed by the union of the medial sural cutaneous nerve (MSCN) and the lateral sural cutaneous nerve (LSCN); the MSCN and LSCN are branches of the tibial and the common fibular (peroneal) nerves, respectively. The site of union was variable: 5.9% in the popliteal fossa, 1.9% in the middle third of the leg, 66.7% in the lower third of the leg, and 25.5% at or just below the ankle. One SN (0.7%) was formed by the union of the MSCN and a different branch of the common fibular nerve, running parallel and medial to but not connecting with the LSCN, which joined the MSCN in the lower third of the leg. The remaining 32.2% of the SNs were a direct continuation of the MSCN. The SNs ranged from 6,30 cm (mean = 14.41 cm) in length with a range in diameter of 3.5,3.8 mm (mean = 3.61 mm), and were easily located 1,1.5 cm posterior to the posterior border of the lateral malleolus. The LSCNs were 15,32 cm long (mean = 22.48 cm) with a diameter between 2.7,3.4 mm (mean = 3.22 mm); the MSCNs were 17,31 cm long (mean = 20.42 cm) with a diameter between 2.3,2.5 mm (mean = 2.41 mm). Clinically, the SN is widely used for both diagnostic (biopsy and nerve conduction velocity studies) and therapeutic purposes (nerve grafting) and the LSCN is used for a sensate free flap; thus, a detailed knowledge of the anatomy of the SN and its contributing nerves are important in carrying out these and other procedures. Clin. Anat. 15:263,266, 2002. © 2002 Wiley-Liss, Inc. [source]