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

Abstract

Documented experience of treatment of digital nerve lesions with the termino-lateral (end-to-side) nerve suture is limited. Our clinical experience of this technique is detailed here alongside a systematic review of the previous literature. We performed, from 2002 to 2008, seven terminolateral sutures with epineural window opening for digital nerve lesions. Functional outcome was analysed using the two-point discrimination test and the Semmes-Weinstein monofilament test. The results showed a sensory recovery of S3þ in six cases and S3 in one case. The mean distance found in the two-point discrimination test was 12.7 mm (range 8-18 mm). After a review of the literature, we were able to obtain homogeneous data from 17 additional patients operated by termino-lateral coaptation. The overall number of cases included in our review was 24. A sensory recovery was observed in 23 out of 24 patients. The functional results were S0 in one case, S3 in one case, S3þ in twenty cases and S4 in two cases. Excluding the one unfavourable case, the mean distance in the two-point discrimination test was 9.7 mm (range 3-18 mm). It can thus be concluded that the treatment of digital nerve lesions with termino-lateral suture showed encouraging results. Based on the results obtained in this current study we believe that in case of loss of substance, endto-side nerve coaptation may be an alternative to biological and synthetic tubulisation when a digital nerve reconstruction by means of nerve autograft is declined by the patient.

Influence of Breaching the Connective Sheaths of the Donor Nerve on Its Myelinated Sensory Axons and on Their Sprouting into the End-to-Side Coapted Nerve in the Rat

“…53,66,69,72,73 Together, these observations support the view that end-to-side nerve coaptation has no major detrimental long-term effect on the donor nerve. This is in accordance with two recent reports of clinical case series, 18,22 in which none of patients had any sensory or motor loss in the innervation zone of the donor nerve, even though perineurial sutures were made after the creation of a perineurial window in the donor nerve. 22 However, electrophysiological and morphometrical testing may not be sensitive enough to detect subtle changes in nociception, especially its positive phenomena (i.e., hyperalgesia, allodynia), which might be induced by minor damage to the donor nerve and could be of relevance to the patient in the case of human application.…”

“…[7][8][9][10][11][12][13][14][15][16] Also, several clinical case series suggest that some patients with extensive nerve injuries in the upper extremity, facial palsy, or neurinoma could benefit by such a treatment, although the results are quite unpredictable. 2,[17][18][19][20][21][22][23][24][25][26][27][28] The basic idea of end-to-side nerve coaptation is to achieve reinnervation of a denervated tissue by the collateral sprouting of uninjured axons from the donor nerve through the distal stump of the injured recipient nerve without sacrificing the innervation of the original targets of the donor nerve. Collateral sprouting of both sensory and motor neurons after this procedure was suggested by several retrograde double labeling studies in rats.…”

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.…”

Hand Injuries in Children

“…The distal nerve stump is coapted to the side of an intact nerve via a perineural window, with reinnervation occurring, due to the sprouting of collateral nerves from the intact neurons into the distal stump [ 78 ]. While both sensory and motor sprouting has been demonstrated in experimental models, clinically it would appear to be more reliable in reconstruction of sensory nerves, such as digital nerve lesions [ 79 ].…”