End-to-side nerve suture in traumatic injuries of brachial plexus: review of the literature and personal case series

Abstract

We used end-to-side nerve coaptation combined with standard end-to-end neurotisations to treat 11 patients who presented with complete (six cases) or incomplete (five cases) traumatic brachial plexus injuries. All patients were available for functional evaluation at a minimum of 2 years postoperatively. In three patients with shoulder abduction recovery, electromyographical studies (EMG) showed a contribution from the end-to-side neurotisation. In the remaining cases end-to-side neurotisations were unsuccessful. Our study did not demonstrate a reliable role for end-to-side nerve suture in brachial plexus surgery. We believe that at present end-to-side suture must not be a substitute for standard reconstructive techniques in brachial plexus surgery. Occasionally termino-lateral nerve sutures may represent a support to standard reconstructive procedures especially in case of severe injuries when few undamaged donor nerves are available.

Clinical Applications of End-to-Side Neurorrhaphy: An Update

“…This study did not demonstrate significant benefits in primary reconstructive surgery for traumatic injuries in adults. In one of these patients an end-to-side coaptation of the hypoglossal to suprascapularis nerve resulted in the recovery of some active shoulder abduction, in contrast to previous study of Ferraresi et al [ 25 , 28 , 29 ]. The usefulness of this technique applied on brachial plexus injuries still remains questionable, overall in adults, where standard neurotizations are more reliable.…”

“…Heterogeneous results can be found in the literature, with the application of this technique in a wide range of conditions [16, 24–28]. …”

“…The first case of end-to-side neurorrhaphy applied on brachial plexus injury was reported by Pienaar et al in 1995, which sutured C5 and C6 roots to the phrenic nerve [ 23 ]. Heterogeneous results can be found in the literature, with the application of this technique in a wide range of conditions [ 16 , 24 – 28 ].…”

End-to-side neurorrhaphy for nerve repair and function rehabilitation

“…At present, the end-to-side neurorrhaphy has been successfully used for re-innervation of face and limbs in peripheral nerve system [8,9]. In the previous experimental and clinical studies, the end-to-side neurorrhaphy was limited to somatic nerves in the peripheral nerve system [6,[10][11][12][13][14][15]. Therefore, the main objective of the study was to determine whether the end-to-side neurorrhaphy for nerve repair is feasible between autonomic nerve and somatic nerve with different characteristic in the peripheral nerve system.…”

Re-Innervation of the Bladder through End-to-Side Neurorrhaphy of Autonomic Nerve and Somatic Nerve in Rats

“…However, in most of the previous experimental and clinical studies, the end-to-side neurorrhaphy technique was limited to somatic nerves of the peripheral nerve system (Battiston et al, 2009;Beris et al, 2007;Bontioti et al, 2005;Jaberi et al, 2003;Mennen et al, 1999;Ozbek and Kurt, 2006). Is it possible to use this technique for nerve repair between autonomic nerve and somatic nerve with different characteristic in the peripheral nerve system?…”