End-to-side neurorrhaphy of sensory nerves

Abstract

One century passed before end-to-side neurorrhaphy was rediscovered, and now it finds more frequent use in clinical practice. Experimental studies have improved our understanding of the underlying mechanism and its potential. However, still discussed is whether reinnervation by end-to-side neurorrhaphy works as well in sensory nerves as in motor nerves. The digital nerves are sensory nerves and therefore an ideal model to investigate this question. Two cases of successful sensory reinnervation by end-to-side nerve suture are reported. We began to use end-to-side nerve repair clinically in 1995 and have used it for motor or sensory reinnervation in a total of 13 cases. In two patients primary nerve repair using end-toside neurorrhaphy was performed in digital avulsion injuries. In one patient the avulsed ulnar nerve of the thumb was sutured end-to-side to the median nerve; in the other the ulnar digital nerve of the ring finger had been destroyed over a distance of 20 mm, and the distal stump was joined end-to-side to the radial nerve of the same finger. Sensory recovery was obtained in both patients. The static two-point discrimination was 3.0 mm, and dynamic two-point discrimination was 2-3 mm for the reinnervated finger compared to 2 mm for static and dynamic two-point discrimination in the adjacent "donor" finger. The sensation of the finger supplied by the "donor nerve" was not altered in relation to the corresponding contralateral finger site. Excellent sensory reinnervation is possible through an end-to-side nerve suture. Proximal avulsion, missing proximal nerve stumps, partial recovery, and prevention of nerve grafts are good indications for resensitization using end-to-side neurorrhaphy. No harm to the donor nerve is expected. Preference should be given to donor nerves that supply skin areas near to the anesthetic area.

Sensory Recovery Outcome after Digital Nerve Repair in Relation to Different Reconstructive Techniques: Meta-Analysis and Systematic Review

“…A detailed overview concerning the selection process is shown in Figure 1. Those remaining 2,997 digital nerve repairs provided the basis for further analysis (Table 2 [3, 25, 34–48], Table 3 [8–12], Table 4 [3, 25, 36, 40, 43, 48–57], Table 5 [14, 58–64], Table 6 [36, 45, 56, 65–68], Table 7 [19, 37, 64, 69–71], and Table 8 [25, 72–77]). Some case reports, which were excluded from the meta-analysis to lower heterogeneity regarding the given sensory recovery outcomes, are nevertheless shown in Tables 2–8.…”

“…An epineural window serves as a connection point between the two nerves, while the extent of the perineural fenestration remains controversial [7]. The end-to-side nerve coaptation can be used to repair severed digital nerves, mostly caused by previous hand injuries, when direct tension-free coaptation is not possible [8–12]. …”

Termino-lateral nerve suture in lesions of the digital nerves: clinical experience and literature review

“…The study of Voche and Quattara (2005) included nine patients operated on for digital nerve lesions and one for a common digital nerve injury. Frey and Giovanoli (2003) reported two clinical cases of terminal-lateral suture of the digital nerve, one of which was completed in 1995 and seems thus to be the first clinical application of this procedure. A further four cases have been recently reported by Landwehrs and Bruser (2008) which used a clinical evaluation based on the two-point discrimination test and the Semmes-Weinstein monofilament test.…”

Epineurial Window Is More Efficient in Attracting Axons than Simple Coaptation in a Sutureless (Cyanoacrylate-Bound) Model of End-to-Side Nerve Repair in the Rat Upper Limb: Functional and Morphometric Evidences and Review of the Literature

“…A number of experimental [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ] as well as clinical [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ] studies have shown that end-to-side nerve coaptation is able to induce collateral sprouting from donor nerve’s axons, allowing for significant repopulation of the distal nerve stump.…”