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Khadanovich A, Benes M, Kaiser R, Herma T, Kachlik D. Clinical anatomy of the lateral antebrachial cutaneous nerve: Is there any safe zone for interventional approach? Ann Anat 2024; 252:152202. [PMID: 38128746 DOI: 10.1016/j.aanat.2023.152202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The lateral antebrachial cutaneous nerve (LACN) is a somatosensory nerve coursing in the lateral portion of the forearm. The nerve is located in a close proximity to the cephalic vein (CV) all along its course with a danger of being injured during venipuncture. The LACN also overlaps and communicates with the superficial branch of the radial nerve (SBRN) in the distal forearm and hand, making the awareness of their relationship of great importance in the treatment of neuroma. The aim of the study was to observe the relationship of the LACN to surrounding structures as well as its branching pattern and distribution. MATERIALS AND METHODS Ninety-three cadaveric forearms embalmed in formaldehyde were dissected. The relationship of the LACN to surrounding structures was noted and photographed, and distances between the structures were measured with a digital caliper. The cross-sectional relationships of the LACN and SBRN to the CV were described using heatmaps. RESULTS The emerging point of the LACN was found distally, proximally or at the level of the interepicondylar line (IEL). The LACN branched in 76 cases (81.7 %) into an anterior and posterior branch at mean distance of 47.8 ± 34.2 mm distal to the IEL. The sensory distribution was described according to the relationship of the LACN branches to the medial border of the brachioradialis muscle. The LACN supplying the dorsum of the hand was observed in 39.8 % of cases. The LACN and the SBRN intersected in 86 % of upper limbs with communications noticed in 71 % of forearms. The LACN was stated as the most frequent donor of the communicating branch resulting in neuroma located distal to the communication and being fed from the LACN. The relationship of the LACN and the CV showed that the IEL is the most appropriate place for the venipuncture due to maximal calibers of the CV and deep position of the LACN. The LACN was adjacent to the cubital perforating vein and the radial artery in all cases. The medial border of the brachioradialis muscle was observed less than 1.8 mm from the LACN. CONCLUSION The study provides morphological data on the LACN distribution, branching pattern and relationship to surrounding structures in a context of clinical use in different spheres of medicine. The branching pattern of the LACN appears to be more constant compared to data provided by previous authors. We emphasized the meaning of cross-sectional relationship of the LACN to the CV to avoid venipuncture outside the cubital fossa if possible. The posterior branch of the LACN was predicted as appropriate donor of the graft for a digital nerve. The LACN appeared to be in a close proximity within the whole length of the brachioradialis muscle what the orthopedic surgeons must be concerned of. The meaning of the donor-nerve of the communicating branch in neuroma treatment was also introduced.
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Affiliation(s)
- Anhelina Khadanovich
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Benes
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radek Kaiser
- Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic; First Faculty of Medicine, Charles University, Prague, Czech Republic; Spinal Surgery Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tomas Herma
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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Pamuk Ç. Digital nerve injury: to repair or not? Ir J Med Sci 2023; 192:2235-2241. [PMID: 36596984 DOI: 10.1007/s11845-022-03268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND There are very few studies comparing patients with and without repair after digital nerve injury. It is still controversial whether digital nerve repair is necessary. AIMS The aim of this study was to evaluate the long-term clinical outcomes of patients with unilateral isolated digital nerve injury who underwent surgical repair and those who did not. METHODS Seventy-four patients with unilateral digital nerve injury were included in the study. Of these, the patients who underwent surgical repair were determined as group A (n = 42), the patients without repair as group B (n = 32), and the groups were divided into subgroups according to injury levels. Results were evaluated with a minimum follow-up of 24 months. RESULTS When the S2PD results were evaluated overall, it was found that those who had digital nerve repair (group A) had significantly better outcomes compared to those without repair (group B) (p = 0.012). When the subgroups were evaluated according to the injury localization, no significant difference was observed at the distal levels, while it was observed that the patients who underwent repair in the proximal levels showed significantly better results (p = 0.003, p = 0.012). CONCLUSION In this study, it was seen that there was no difference between the results of repair and non-repair of unilateral nerve injuries distal to the middle level of the middle phalanx, but repair is required in injuries proximal to this level.
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Affiliation(s)
- Çağdaş Pamuk
- Orthopedics and Traumatology Department, Private Silivri Anadolu Hospital, Istanbul, Turkey.
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Zhang Y, Hou N, Zhang J, Xie B, Liang J, Chang X, Wang K, Tang X. Treatment options for digital nerve injury: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:675. [PMID: 37700356 PMCID: PMC10496177 DOI: 10.1186/s13018-023-04076-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Surgical treatment of finger nerve injury is common for hand trauma. However, there are various surgical options with different functional outcomes. The aims of this study are to compare the outcomes of various finger nerve surgeries and to identify factors associated with the postsurgical outcomes via a systematic review and meta-analysis. METHODS The literature related to digital nerve repairs were retrieved comprehensively by searching the online databases of PubMed from January 1, 1965, to August 31, 2021. Data extraction, assessment of bias risk and the quality evaluation were then performed. Meta-analysis was performed using the postoperative static 2-point discrimination (S2PD) value, moving 2-point discrimination (M2PD) value, and Semmes-Weinstein monofilament testing (SWMF) good rate, modified Highet classification of nerve recovery good rate. Statistical analysis was performed using the R (V.3.6.3) software. The random effects model was used for the analysis. A systematic review was also performed on the other influencing factors especially the type of injury and postoperative complications of digital nerve repair. RESULTS Sixty-six studies with 2446 cases were included in this study. The polyglycolic acid conduit group has the best S2PD value (6.71 mm), while the neurorrhaphy group has the best M2PD value (4.91 mm). End-to-side coaptation has the highest modified Highet's scoring (98%), and autologous nerve graft has the highest SWMF (91%). Age, the size of the gap, and the type of injury were factors that may affect recovery. The type of injury has an impact on the postoperative outcome of neurorrhaphy. Complications reported in the studies were mainly neuroma, cold sensitivity, paresthesia, postoperative infection, and pain. CONCLUSION Our study demonstrated that the results of surgical treatment of digital nerve injury are generally satisfactory; however, no nerve repair method has absolute advantages. When choosing a surgical approach to repair finger nerve injury, we must comprehensively consider various factors, especially the gap size of the nerve defect, and postoperative complications. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Yi Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
- Department of Hand and Foot Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
| | - Nianzong Hou
- Department of Hand and Foot Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
- Center of Gallbladder Disease, Shanghai East Hospital, Institute of Gallstone Disease, School of Medicine, Tongji University, Shanghai, China
| | - Jian Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
| | - Bing Xie
- Department of Hand and Foot Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
| | - Jiahui Liang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
| | - Xiaohu Chang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
| | - Kai Wang
- Department of Critical Care Medicine, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
| | - Xin Tang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
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Cegarra-Escolano M, Jaloux C, Poumellec MA, Balaguer T, Baqué P, Bronsard N, Camuzard O. Vascularization of the lateral and medial antebrachial cutaneous nerves by cutaneous perforator arteries: An anatomical study. HAND SURGERY & REHABILITATION 2021; 40:241-249. [PMID: 33757862 DOI: 10.1016/j.hansur.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/28/2022]
Abstract
The forearm is an interesting donor site for non-vascularized nerve grafts, especially hand surgeons. Very few studies have described the use of the lateral and medial antebrachial cutaneous nerves (LABCN and MABCN, respectively) as vascularized nerve grafts (VNGs). The aim of this anatomical study was to analyze the characteristics and vascularization of these nerves to describe new potential donor sites for VNGs. Twelve forearms were dissected from fresh cadavers injected with red latex. The number of terminal branches, lengths, and proximal and distal diameters of both the LABCN and MABCN were studied. An anatomical description of the cutaneous perforator arteries from the radial and ulnar arteries that vascularized the nerve was also recorded: number of perforators, length, type of perforator (septo- or musculocutaneous), and location within the forearm (proximal, middle, and distal third). In over 80% of the specimens, the cutaneous perforator arteries from the radial and ulnar artery vascularized the LABCN and the MABCN, respectively. These arteries, found mostly in the proximal third of the forearm, had diameters >0.5mm. Most of them came from the radial and ulnar arteries (for LABCN and MABCN vascularization, respectively). In over 75% of the specimens, the nutrient arteries of both nerves also vascularized the superficial veins and the skin. We found that these nerves are vascularized by perforators arteries, which also participate in vein and skin vascularization. Altogether, this anatomical study shows that reconstructive surgeons could use new VNGs based on the perforator artery of the forearm.
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Affiliation(s)
- M Cegarra-Escolano
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France
| | - C Jaloux
- Department of Plastic and Reconstructive Surgery, La Conception Hospital, Marseille, France
| | - M-A Poumellec
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France
| | - T Balaguer
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France
| | - P Baqué
- Laboratoire d'Anatomie Normale, Faculté de Médecine de Nice, University of Côte d'Azur, 28 Avenue de Valombrose, 06107 Nice, France; Service de Chirurgie viscérale d'urgence, Hôpital Pasteur 2, University of Côte d'Azur, 30 Voie romaine, 06000 Nice, France
| | - N Bronsard
- Laboratoire d'Anatomie Normale, Faculté de Médecine de Nice, University of Côte d'Azur, 28 Avenue de Valombrose, 06107 Nice, France; Department of Orthopedic Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France
| | - O Camuzard
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France; Laboratoire d'Anatomie Normale, Faculté de Médecine de Nice, University of Côte d'Azur, 28 Avenue de Valombrose, 06107 Nice, France; UMR E-4320 TIRO-MATOs CEA/DRF/BIAM, University of Côte d'Azur, 28 Avenue de Valombrose, 06107 Nice, France.
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Namazi H, Sobhani A, Gholamzadeh S, Dehghanian A, Dehghani Nazhvani F. Donor nerve graft assessment for covering thumb nerve defects: a cadaveric study. J Orthop Surg Res 2020; 15:456. [PMID: 33023607 PMCID: PMC7541239 DOI: 10.1186/s13018-020-01974-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though several studies reported donor autologous nerve grafts for digital nerve defects, there is no report in the literature regarding acceptable graft for thumb nerves. The purpose of this study is to provide guidelines for autologous nerve graft selection by detecting similarities between thumb nerve zones and donor nerve with regard to the number of fascicles and cross-sectional area. MATERIALS AND METHODS Five cadavers were used in this study. An anatomical zoning system was defined for thumb nerves (zones 1, 2, 3). Sural nerve (SN), medial antebrachial cutaneous nerve (MABCN), lateral antebrachial cutaneous nerve (LABCN), posterior interosseous nerve (PIN), and anterior interosseous nerve (AIN) were selected as donor nerve grafts. The number of fascicles and surface area (mm2) was defined. RESULTS The mean of the fascicle number in zone 1, zone 2, zone 3, AIN, PIN, LABCN, MABCN, and SN were 3.8, 4.7, 6.1, 2.2, 1.8, 4.5, 3.1, and 6.4, respectively. The mean of the surface area in zone 1, zone 2, zone 3, AIN, PIN, LABCN, MABCN, and SN were 2.19, 6.26, 4.04, 1.58, 0.71, 5.00, 3.01, and 8.06, respectively. CONCLUSIONS LABCN is the best choice for all zones that has fascicular matching with all three zones of thumb nerves and caliber matching with zones 2 and 3. In zone 1, the best nerve graft is MABCN which has both suitable caliber and fascicle count.
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Affiliation(s)
- Hamid Namazi
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Sobhani
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Gholamzadeh
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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Herman ZJ, Ilyas AM. Sensory Outcomes in Digital Nerve Repair Techniques: An Updated Meta-analysis and Systematic Review. Hand (N Y) 2020; 15:157-164. [PMID: 31043071 PMCID: PMC7076611 DOI: 10.1177/1558944719844346] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Injuries to digital nerves are common with trauma to the hand, often requiring surgery. Surgical management of these injuries can be performed using several techniques: direct repair (neurorrhaphy), autograft, allograft, and conduit repair. In light of increasing the availability and use of various digital nerve repair techniques, a new systematic review and meta-analysis was undertaken to comparatively review the available evidence to determine any differences in outcomes to better guide treatment in cases with digital nerve gaps. Methods: Current literature on sensory outcomes of various digital nerve repair techniques was reviewed using static 2-point discrimination (S2PD), moving 2-point discrimination (M2PD), Semmes-Weinstein monofilament testing (SWMF), and complication rates as outcomes of interest. After inclusion and exclusion criteria were applied, 15 articles were reviewed and 625 nerve repairs were analyzed. Results: The average gap length for allograft repair, autograft repair, and conduit repair was 15.4, 24.7, and 13.4 mm, respectively. For S2PD outcomes, autograft repair was statistically superior to all other forms of repair. Allograft trended higher than neurorrhaphy and conduit repair, but results were not statistically significant. For SWMF outcomes, autograft repair was statistically superior to conduit repair and neurorrhaphy; it was statistically comparable with allograft repair. Allograft performed statistically superior to conduit repair relative to M2PD. Conclusions: Based on the current updated meta-analysis using newer data and techniques, we found that all available techniques have reasonable outcomes. Yet when managing a digital nerve injury with a gap, thereby excluding direct neurorrhaphy, both autograft and allograft performed comparably and were superior to conduit repair.
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Affiliation(s)
- Zachary J. Herman
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA,Zachary J. Herman, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street #100, Philadelphia, PA 19107, USA.
| | - Asif M. Ilyas
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Functional assessment and quality of life in patients following replantation of the distal half of the forearm (except fingers): A review of 11 cases. HAND SURGERY & REHABILITATION 2017; 36:261-267. [DOI: 10.1016/j.hansur.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 02/19/2017] [Accepted: 05/31/2017] [Indexed: 11/22/2022]
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Abstract
Care of the reconstructed hand following mutilating injury is akin to the care of a vintage car. Its mechanisms are delicate, spare parts are limited, touch-ups are required often, and a major overhaul is indicated rarely. Secondary interventions are indicated for completion of staged primary procedures, management of complications, targeted improvement of function, and enhancement of appearance of the reconstructed hand. The approach to secondary reconstruction depends on the patient's age, and vocational and recreational requirements. It is also influenced by the constant evolution of surgeons' reconstructive philosophy, experience, and technology.
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Affiliation(s)
- Anthony Foo
- Department of Hand & Reconstructive Microsurgery, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore.
| | - Sandeep J Sebastin
- Department of Hand & Reconstructive Microsurgery, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore
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