Nerve Transfer Versus Nerve Graft for Reconstruction of High Ulnar Nerve Injuries

Sallam, Asser; El-Deeb, Mohamed S; Imam, Mohamed A.

doi:10.1016/j.jhsa.2017.01.027

Cited by 45 publications

(36 citation statements)

References 32 publications

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“…60 The outcomes for this procedure may be superior to proximal ulnar grafting for both motor and functional hand outcomes. 33,67 Of note, some authors have suggested the use of the end-to-side or "supercharge" repair, in which the distal AIN is grafted onto the side of the ulnar motor branch while maintaining the continuity of the proximal ulnar nerve (Fig. 2).…”

Section: Hand and Wrist Reanimationmentioning

confidence: 99%

Surgery for nerve injury: current and future perspectives

Midha

Grochmal

2019

Journal of Neurosurgery

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In this review article, the authors offer their perspective on nerve surgery for nerve injury, with a focus on recent evolution of management and the current surgical management. The authors provide a brief historical perspective to lay the foundations of the modern understanding of clinical nerve injury and its evolving management, especially over the last century. The shift from evaluation of the nerve injury using macroscopic techniques of exploration and external neurolysis to microscopic interrogation, interfascicular dissection, and internal neurolysis along with the use of intraoperative electrophysiology were important advances of the past 50 years. By the late 20th century, the advent and popularization of interfascicular nerve grafting techniques heralded a major advance in nerve reconstruction and allowed good outcomes to be achieved in a large percentage of nerve injury repair cases. In the past 2 decades, there has been a paradigm shift in surgical nerve repair, wherein surgeons are not only directing the repair at the injury zone, but also are deliberately performing distal-targeted nerve transfers as a preferred alternative in an attempt to restore function. The peripheral rewiring approach allows the surgeon to convert a very proximal injury with long regeneration distances and (often) uncertain outcomes to a distal injury and repair with a greater potential of regenerative success and functional recovery. Nerve transfers, originally performed as a salvage procedure for severe brachial plexus avulsion injuries, are now routinely done for various less severe brachial plexus injuries and many other proximal nerve injuries, with reliably good to even excellent results. The outcomes from nerve transfers for select clinical nerve injury are emphasized in this review. Extension of the rewiring paradigm with nerve transfers for CNS lesions such as spinal cord injury and stroke are showing great potential and promise. Cortical reeducation is required for success, and an emerging field of rehabilitation and restorative neurosciences is evident, which couples a nerve transfer procedure to robotically controlled limbs and mind-machine interfacing. The future for peripheral nerve repair has never been more exciting.

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Section: Hand and Wrist Reanimationmentioning

confidence: 99%

Surgery for nerve injury: current and future perspectives

Midha

Grochmal

2019

Journal of Neurosurgery

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“…This technique involves reallocating expendable and redundant neural input via donor nerves to reinnervate and restore function of the injured distribution. Nerve transfers are capable of shortening regenerative distances and thereby recovery time, and have been shown to permit more rapid neural recovery than primary nerve grafting alone 6,7 …”

Section: Introductionmentioning

confidence: 99%

Nerve transfers to restore femoral nerve function following oncologic nerve resection

O’Brien

West

Zewdu

et al. 2021

Journal of Surgical Oncology

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Introduction Advances in the care of soft‐tissue tumors, including imaging capabilities and adjuvant radiation therapy, have broadened the indications and opportunities to pursue surgical limb salvage. However, peripheral nerve involvement and femoral nerve resection can still result in devastating functional outcomes. Nerve transfers offer a versatile solution to restore nerve function following tumor resection. Methods Two cases were identified by retrospective review. Patient and disease characteristics were gathered. Preoperative and postoperative motor function were assessed using the Medical Research Council Muscle Scale. Patient‐reported pain levels were assessed using the numeric rating scale. Results Nerve transfers from the obturator and sciatic nerve were employed to restore knee extension. Follow up for Case 1 was 24 months, 8 months for Case 2. In both patients, knee extension and stabilization of gait without bracing was restored. Patient also demonstrated 0/10 pain (an average improvement of 5 points) with decreased neuromodulator and pain medication use. Conclusion Nerve transfers can restore function and provide pain control benefits and ideally are performed at the time of tumor extirpation. This collaboration between oncologic and nerve surgeons will ultimately result in improved functional recovery and patient outcomes.

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“…3 In response to these poor results following ulnar nerve repair or tendon transfer, a few surgeons advocate transferring the distal anterior interosseous nerve (AIN) to the deep branch of the ulnar nerve (DBUN). 9e14 With this nerve transfer, outcomes are better than with nerve grafting 11,13 ; however, functional improvement is observed in only one-third of the patients. 11 Limited functional improvement after AIN to DBUN nerve transfer might be a consequence of poor recovery of the muscles of the first web space given that, in a series of 24 patients, Sallam et al 13 acknowledged reinnervation of the ADP but not the FDI muscle.…”

mentioning

confidence: 99%

“…9e14 With this nerve transfer, outcomes are better than with nerve grafting 11,13 ; however, functional improvement is observed in only one-third of the patients. 11 Limited functional improvement after AIN to DBUN nerve transfer might be a consequence of poor recovery of the muscles of the first web space given that, in a series of 24 patients, Sallam et al 13 acknowledged reinnervation of the ADP but not the FDI muscle. Poor reinnervation of the FDI and ADP after AIN to DBUN nerve transfer might result from an inadequate number of nerve fibers in the AIN 9,14,15 and the proximal to distal sequence of reinnervation, 15 with proximal muscles possibly attracting more axons.…”

mentioning

confidence: 99%