Nerve Grafting And Neuromuscular Transfers

Microsurgical treatment of injury to peripheral nerves in upper and lower limbs: a critical review of the last 8 years

Nerve injuries to the upper and inferior limbs represent a common event due both to home and working accidents. Minor traumas can lead to severe disabilities if a wrong treatment is carried out. From 1997 to 2005, 920 patients were observed with a total of 1,200 major or minor nerves injuries operated. In 852 cases acute lesions treated. In 68 patients we reviewed old injuries. In 707 patients direct nerve suture and in 145 patients nerve grafts were carried out. One to 8 years follow up observed. Different protocols were adopted according to the injury: simple cut, complex lesion or surgical revision. Results were evaluated during the follow up period with different models: motor evaluation in six levels (BMRC), sensitive evaluation in five levels (HIGHET), and global evaluation with four grades (from the worst to the best result). Nerve healing is a complex biological phenomenon influenced by many parameters related both to the patient characteristics and nerve lesion. Functional and esthetical outcomes vary also according to: age, cultural and economic condition, health status, and smoking. Post operative rehabilitation is mandatory to obtain an acceptable functional result. Nerve injuries to the upper and inferior limbs represent a challenge for the microsurgeon. Ultimate success in nerve surgery is judged by functional as well as cosmetic parameters. Only patients with the appropriate indication should be operated and always by a skilled surgeon.

Effects of nerve growth factor on the neurotization of denervated muscles

Studies on surgical repair techniques of the peripheral nerve are still trying to improve the outcome. There are many studies on the effects of various neurotrophic factors on the transected peripheral nerve. Muscular neurotization, which is the direct implantation of the nerve to the target denervated skeletal muscle, is one of the techniques used when the primary repair of the peripheral nerves is not possible. The effects of nerve growth factor (NGF), which is one of the primary neurotrophic factors, on the reinnervation of denervated muscles by neurotization is investigated in this experimental study. The denervated soleus muscle was neurotized via peroneal nerve implantation (group 1), and NGF was administered to the neurotized muscle (group 2). All animals were evaluated at weeks 8, 10, and 12 using electromyography. Muscle contractility, muscle weight, and histological morphometric tests were performed at week 12. The experimental groups were compared with each other and normal control values. Electromyographically, group 2 (direct nerve implantation + NGF) demonstrated better reinnervation in all evaluations. The study of muscle weight showed that the muscle mass was 75% of the normal soleus muscle in group 1 and was 85% of the normal side in group 2 at the end of week 12. In group 1, the twitch force was 56% of the normal soleus muscle and was 71% in group 2. Tetanic force was 53% of the normal soleus muscle in group 1 and 68% in group 2. Histological morphometric studies revealed that there was a decrease in the density of the motor end plates in group 1, but there was no statistically significant difference between the normal soleus muscles and the NGF applied to group 2. The positive effects of NGF on the neurotization of denervated muscles seen in this study suggest that it may be useful for treating some difficult reconstructions caused by denervation.