An Analysis of the Results of Late Reconstruction of 132 Median Nerves

Kallio, P. K.; Vastamäki, Martti

doi:10.1016/0266-7681(93)90205-t

Cited by 119 publications

(63 citation statements)

References 15 publications

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“…Motor function recovery of grade 2 or less was observed in 11 patients (20%). 19 Kallio and Vastamaki 20 described 132 patients with injuries to the median nerve. Fascicular grafting was performed in 98 cases.…”

Section: Discussionmentioning

confidence: 99%

Poor results after nerve grafting in the upper extremity: Quo vadis?

Meek¹,

Coert²,

Robinson³

2005

Microsurgery

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The clinical success of peripheral nerve grafting in the upper extremity was evaluated retrospectively in 41 patients. This study comprises a 10-year follow-up in a single institution. Donor and acceptor site morbidity as well as functional nerve recovery were evaluated. Thirty-one men and 10 women were included. Autologous nerve grafts were used for reconstruction of digital nerves in 17 patients, ulnar nerves in 12 patients, median nerves in 10 patients, radial nerve in 1 patient, and both the radial and median nerve in 1 patient. The length of nerve grafts ranged from 1-12.5 cm (mean, 4.8 cm). The follow-up period ranged from 18 months to 10 years. Acceptor site-related problems were noted in 51%% (n = 21) of patients. Donor-site morbidity was seen in 4 patients (10%%). The return of function was scored as "good" in 3 (7%%), "fair" in 11 (27%%), and "bad" in 27 (66%%) patients. The outcome of autologous nerve grafts in this small group of patients treated by several surgeons was unfavorable in terms of function. Recent experimental and clinical studies with biodegradable nerve guides for the repair of peripheral nerve gaps showed superior results in comparison to classic nerve grafts.

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Section: Discussionmentioning

confidence: 99%

Poor results after nerve grafting in the upper extremity: Quo vadis?

Meek¹,

Coert²,

Robinson³

2005

Microsurgery

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“…In a study by Kallio, published after the above-mentioned reviews, analyzing the late reconstruction of 132 median nerves using secondary nerve repair or fascicular grafting, 13 they subdivided their patients based upon age, distance from the middle finger to repair, length of nerve gap, and crush versus sharp division. Respectively, they found S4 level of recovery in 28%, M5 in 4% and M4 in 56% of those >40 years of age.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the human median nerve in the forearm with the Neurotube™

2007

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Reconstruction of the median nerve in the forearm traditionally has required multiple interfascicular interposition autologous nerve grafts. Recovery of two-point discrimination, even in young adults, has been reported rarely. Two patients, aged 43 and 61, are reported with 5-year follow-up of median nerve reconstruction in the distal forearm in which multiple interposition bioabsorbable polyglycolic acid conduits (Neurotube) were used to bridge the 3-cm nerve defects. Four separate 2.3-mm diameter, 4.0-cm long conduits were used in each patient. Sensory re-education was used for rehabilitation. Each patient recovered two-point discrimination with good localization in the thumb, index, and middle finger by 2 years after the nerve reconstruction. Both patients recovered abductor pollicis brevis function.

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“…The less severely injured patients achieved significantly better function. In comparison, Kallio and Vastamaki 12 found mean functions of 33% and 30%, respectively, 10.4 years after repair in 132 patients with a mean age of 28.4 years.…”

Section: Median Nerve Injuriesmentioning

confidence: 95%

“…The period of muscle stimulation ranged from 127 to 346 days. 12 Explantation of the system was performed at the time of reinnervation, as determined clinically and confirmed with electromyography. Muscle biopsies were performed at both implantation and explantation.…”

Section: Clinical Studymentioning

confidence: 99%

Muscle preservation using an implantable electrical system after nerve injury and repair

Nicolaidis

Williams

2001

Microsurgery

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The value of continuous electrical stimulation of denervated muscles after nerve injury and repair has been clearly shown in a series of laboratory experiments in three animal models. This experimental background, which showed improved muscle preservation and better functional results, evolved into a clinical study that included 15 patients with peripheral nerve injuries in the upper extremities, 3 patients with brachial plexus injuries, and three patients with facial nerve paralysis. Improved functional results were obtained using this implantable system, which were similar to those achieved with the animal experiments. All patients had muscle stimulation for extended periods ranging from 127 to 346 days. Analysis of the results showed satisfactory nerve regeneration on clinical examination and with electromyographic studies. Functional muscle analysis varied somewhat from patient to patient, but every patient had a satisfactory to excellent recovery. The results from this study have clearly shown the benefits of continuous muscle stimulation using an implantable electrical system after nerve injury and repair expansion of the project to a larger patient cohort is indicated.

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An Analysis of the Results of Late Reconstruction of 132 Median Nerves

Cited by 119 publications

References 15 publications

Poor results after nerve grafting in the upper extremity: Quo vadis?

Poor results after nerve grafting in the upper extremity: Quo vadis?

Reconstruction of the human median nerve in the forearm with the Neurotube™

Muscle preservation using an implantable electrical system after nerve injury and repair

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