Vascularized Ulnar Nerve Graft: 151 Reconstructions for Posttraumatic Brachial Plexus Palsy

Terzis, Julia K.; Kostopoulos, V.

doi:10.1097/prs.0b013e31819f2afd

Cited by 44 publications

(42 citation statements)

References 38 publications

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“…However, in cases with poor recipient beds, and/or where large-calibre and/or long nerve grafts are required, then non-VNGs are less effective (1). This is confirmed in a recent literature review and large retrospective case series based on one institution's 23 years of experience repairing median nerve deficits, suggesting VNGs are superior to nonvascular nerve grafts (1).…”

Section: Discussionsupporting

confidence: 52%

“…Favourable prognostic factors for the use of ulnar VNGs to repair median nerve deficits are decreased delay from injury to surgery, harvest of the ulnar VNG from the ipsilateral arm, younger age, and distal rather than proximal lesions (1,11). Interestingly, there does not appear to be a significant difference in functional results when free versus pedicled ulnar VNGs are used (1).…”

Section: Discussionmentioning

confidence: 99%

“…The use of ulnar VNGs to repair avulsion injuries to the median nerve are favoured in heavily scarred environments and when the ulnar nerve is not salvageable (1). While the restoration of protective sensation in the median nerve distribution has been consistently documented (1,2,4-7), the return of well-documented significant measurable improvements in median nerve motor function is variable (1,2,4-10).…”

mentioning

confidence: 99%

“…While randomized controlled studies comparing VNGs and nonVNGs are lacking, most evidence suggests that VNGs produce superior results clinically and experimentally (1). Factors that warrant the use of VNGs over conventional nerve grafts are long graft length, poor vascular supply of the recipient bed, large-calibre nerve reconstruction, and prolonged denervation time from injury to presentation (1). Strange (2) described the first pedicled nerve graft where an ulnar VNG was used to repair a median nerve defect (2).…”

mentioning

confidence: 99%

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Meaningful power grip recovery after salvage reconstruction of a median nerve avulsion injury with a pedicled vascularized ulnar nerve

et al. 2015

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Meaningful power grip recovery after salvage reconstruction of a median nerve avulsion injury with a pedicled vascularized ulnar nerve

et al. 2015

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“…The rare exceptions include using the ulnar nerve in the presence of lower trunk brachial plexus injuries (including C8-T1 avulsions) in which reanimation of ulnar nerve function following proximal repair is statistically very unlikely or with multiple extremity injuries in which nerves from an otherwise unsalvageable and/ or amputated limb can be utilized. Transfer as a pedicled or free vascularized graft 19 or splitting the graft into multiple thin strands 5 can circumvent any perfusion concerns and have all been successfully incorporated into clinical practice.…”

Section: Discussionmentioning

confidence: 99%

A Preliminary Assessment of the Utility of Large-Caliber Processed Nerve Allografts for the Repair of Upper Extremity Nerve Injuries

Isaacs

Safa²

2016

Hand (New York, N,Y.)

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Background: Cabled sensory nerve autografts are the historical gold standard for overcoming gaps in larger diameter nerves as repair utilizing large-diameter autograft risks central graft necrosis. Commercially available processed nerve allograft (PNA) is available in diameters up to 5 mm but represents an acellular 3-dimensional matrix as opposed to viable tissue. The purpose of this study is to specifically evaluate whether similar concerns regarding the use of large-caliber PNA are warranted. Methods: The RANGER Registry is an active database designed to collect injury, repair, safety, and outcomes data for PNAs (Avance® Nerve Graft; AxoGen, Inc, Alachua, Florida) according to an institutional review board-approved protocol. The database was queried for patients presenting with large-caliber nerve allograft repairs in the upper extremity. Identified patients reporting quantitative outcomes with a minimum of 9-month follow-up were included in the data set. Results: The large-caliber PNA subgroup included 13 patients with 15 injuries. The mean ± SD age was 36 ± 22 years. Large-caliber single-stranded repairs included twelve 4-to 5-mm-diameter grafts. Large-caliber cabled repairs included the combined use of 3-to 4-mm and 4-to 5-mm-diameter nerve allografts in 3 repairs. The mean nerve gap was 33 ± 10 mm with a mean follow-up time of 13 months. Available quantitative data reported meaningful recovery of sensory and motor function in 67% and 85% of the repairs, respectively. Conclusion: Although based on a small subset of patients, PNAs of up to 5 mm in diameter appear capable of supporting successful nerve regeneration.

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Comparison of Conventional, Revascularized, and Bioengineered Methods of Recurrent Laryngeal Nerve Reconstruction

Sand

Park

Bhatt

et al. 2016

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Damage to the recurrent laryngeal nerve (RLN) is highly detrimental to voice, swallow, and cough. The optimal method for reconstitution of a nerve gap after injury is unknown. OBJECTIVE To evaluate multiple methods of RLN reconstruction. DESIGN, SETTING, AND PARTICIPANTS This study used an established canine model of RLN injury to examine purpose-bred, conditioned, female, 20-kg mongrel hounds at Washington University. A total of 32 dogs were examined, with 63 experiments performed. INTERVENTIONS Surgical transection or excision of the RLN with reconstruction by multiple methods. MAIN OUTCOMES AND MEASURES Six months after injury repair, laryngeal adductor pressures (LAPs), spontaneous and stimulable movement, and graft axon counts by histologic analysis were assessed. RESULTS Simple RLN transection with direct neurorrhaphy provided a mean (SD) recovery of 55.5% (12.5%) of baseline LAPs (P = .18 for comparison of LAP recovery among cases from the conventional nerve graft [39.4% (22.2%)]; P = .63 for comparison of LAP recovery among cases from the reverse autograft [60.8% (27.5%)]). Revascularized grafts provided a recovery of 54.5% (46.4%) while short and long acellular grafts provided recoveries of 60.4% (NA) and 39.5% (17.0%). Two of 11 polyglycolic acid reconstructions provided a measurable LAP with a mean (SD) recovery of 37.1% (8.9%) of baseline. Reconstruction with a neural conduit in any condition provided no measurable LAP recovery.

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Vascularized Ulnar Nerve Graft: 151 Reconstructions for Posttraumatic Brachial Plexus Palsy

Cited by 44 publications

References 38 publications

Meaningful power grip recovery after salvage reconstruction of a median nerve avulsion injury with a pedicled vascularized ulnar nerve

Meaningful power grip recovery after salvage reconstruction of a median nerve avulsion injury with a pedicled vascularized ulnar nerve

A Preliminary Assessment of the Utility of Large-Caliber Processed Nerve Allografts for the Repair of Upper Extremity Nerve Injuries

Comparison of Conventional, Revascularized, and Bioengineered Methods of Recurrent Laryngeal Nerve Reconstruction

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