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Bateman EA, Larocerie-Salgado J, Ross DC, Miller TA, Pripotnev S. Assessment, patient selection, and rehabilitation of nerve transfers. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1267433. [PMID: 38058570 PMCID: PMC10696649 DOI: 10.3389/fresc.2023.1267433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023]
Abstract
Peripheral nerve injuries are common and can have a devastating effect on physical, psychological, and socioeconomic wellbeing. Peripheral nerve transfers have become the standard of care for many types of peripheral nerve injury due to their superior outcomes relative to conventional techniques. As the indications for, and use of, nerve transfers expand, the importance of pre-operative assessment and post-operative optimization increases. There are two principal advantages of nerve transfers: (1) their ability to shorten the time to reinnervation of muscles undergoing denervation because of peripheral nerve injury; and (2) their specificity in ensuring proximal motor and sensory axons are directed towards appropriate motor and sensory targets. Compared to conventional nerve grafting, nerve transfers offer opportunities to reinnervate muscles affected by cervical spinal cord injury and to augment natural reinnervation potential for very proximal injuries. This article provides a narrative review of the current scientific knowledge and clinical understanding of nerve transfers including peripheral nerve injury assessment and pre- and post-operative electrodiagnostic testing, adjuvant therapies, and post-operative rehabilitation for optimizing nerve transfer outcomes.
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Affiliation(s)
- Emma A. Bateman
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Parkwood Institute, St Joseph’s Health Care London, London, ON, Canada
| | | | - Douglas C. Ross
- Roth McFarlane Hand & Upper Limb Centre, St Joseph’s Health Care London, London, ON, Canada
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Thomas A. Miller
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Parkwood Institute, St Joseph’s Health Care London, London, ON, Canada
| | - Stahs Pripotnev
- Roth McFarlane Hand & Upper Limb Centre, St Joseph’s Health Care London, London, ON, Canada
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Jack AS, Chan VKY, Mehta V, Jacques L. Resident peripheral nerve surgery competence: An assessment of procedural exposure, self-reported competence and technical ability. Clin Neurol Neurosurg 2022; 219:107312. [PMID: 35716455 DOI: 10.1016/j.clineuro.2022.107312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Identifying peripheral nerve surgery procedure (PNSP) competencies is crucial to ensure adequate resident training. We examine PNSP training at neurosurgical centers in the US and Canada to compare resident-reported competence, PNSP exposure, and resident technical abilities in performing 3 peripheral nerve coaptations (PNC). METHODS Resident-reported PNSP competence and PNSP exposure data were collected using questionnaires from neurosurgical residents at North American neurosurgical training centers. Exposure and self-reported competency were correlated with technical skills. Technical PNC variables collected included: time-to-completion, nerve-handling from video-analysis, independent and blinded visual-analog-scale (VAS) PNC quality grading by 3 judges, and training level. RESULTS A total of 40 neurosurgical residents participated in the study. Although self-reported competency scores correlated with procedural exposure (P < 0.01, rs = 0.88), a discrepancy was found between the degree of self-reported competency and amount of exposure. The discrepancy was greater in senior residents. A significant VAS difference was found between PNC types with the direct-suture and connector-assister groups scoring higher than connector-only (P = 0.02, P < 0.01, respectively). No difference was observed between training level and VAS grading, nor time-to completion (P = 0.33 and 0.25, respectively). No correlation was found between self-reported competency performing PNSPs and PNC VAS scores, nor nerve handling. CONCLUSIONS Despite more exposure and a higher self-reported PNSP competency in senior residents, no difference was seen between senior/junior residents in PNC quality. A discrepancy in PNSP exposure and self-reported competency exists. This information will provide guidance for the direction of resident PNS training.
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Affiliation(s)
- Andrew S Jack
- Division of Neurological Surgery, University of California San Francisco (UCSF), 400 Parnassus Ave, San Francisco, CA 94122, USA; Division of Neurosurgery, University of Alberta, 8440-112 Street, Edmonton, AB T6G-2B7, Canada.
| | - Vivien K-Y Chan
- Division of Neurosurgery, University of Alberta, 8440-112 Street, Edmonton, AB T6G-2B7, Canada
| | - Vivek Mehta
- Division of Neurosurgery, University of Alberta, 8440-112 Street, Edmonton, AB T6G-2B7, Canada
| | - Line Jacques
- Division of Neurological Surgery, University of California San Francisco (UCSF), 400 Parnassus Ave, San Francisco, CA 94122, USA
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Rasulić L, Simić V, Savić A, Lepić M, Kovačević V, Puzović V, Vitošević F, Novaković N, Samardžić M, Rotim K. MANAGEMENT OF BRACHIAL PLEXUS MISSILE INJURIES. Acta Clin Croat 2018; 57:487-496. [PMID: 31168182 PMCID: PMC6536276 DOI: 10.20471/acc.2018.57.03.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
SUMMARY – Missile injuries are among the most devastating injuries in general traumatology. Traumatic brachial plexus injuries are the most difficult injuries in peripheral nerve surgery, and most complicated to be surgically treated. Nevertheless, missile wounding is the second most common mechanism of brachial plexus injury. The aim was to evaluate functional recovery after surgical treatment of these injuries. Our series included 68 patients with 202 nerve lesions treated with 207 surgical procedures. Decision on the treatment modality (exploration, neurolysis, graft repair, or combination) was made upon intraoperative finding. Results were analyzed in 60 (88.2%) patients with 173 (85.6%) nerve lesions followed-up for two years. Functional recovery was evaluated according to functional priorities. Satisfactory functional recovery was achieved in 90.4% of cases with neurolysis and 85.7% of cases with nerve grafting. Insufficient functional recovery was verified in ulnar and radial nerve lesions after neurolysis, and in median and radial nerve lesions when graft repair was done. We conclude that the best time for surgery is between two and four months after injury, except for the gunshot wound associated with injury to the surrounding structures, which requires immediate surgical treatment. The results of neurolysis and nerve grafting were similar.
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Affiliation(s)
| | - Vesna Simić
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Section for Neurosurgery, Department of Surgery, Ćuprija General Hospital, Ćuprija, Serbia; 4Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 5Department of Neurosurgery, Kragujevac Clinical Center, Kragujevac, Serbia; 6Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; 7Neuroradiology Department, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 9University of Applied Health Sciences
| | - Andrija Savić
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Section for Neurosurgery, Department of Surgery, Ćuprija General Hospital, Ćuprija, Serbia; 4Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 5Department of Neurosurgery, Kragujevac Clinical Center, Kragujevac, Serbia; 6Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; 7Neuroradiology Department, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 9University of Applied Health Sciences
| | - Milan Lepić
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Section for Neurosurgery, Department of Surgery, Ćuprija General Hospital, Ćuprija, Serbia; 4Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 5Department of Neurosurgery, Kragujevac Clinical Center, Kragujevac, Serbia; 6Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; 7Neuroradiology Department, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 9University of Applied Health Sciences
| | - Vojin Kovačević
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Section for Neurosurgery, Department of Surgery, Ćuprija General Hospital, Ćuprija, Serbia; 4Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 5Department of Neurosurgery, Kragujevac Clinical Center, Kragujevac, Serbia; 6Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; 7Neuroradiology Department, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 9University of Applied Health Sciences
| | - Vladimir Puzović
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Section for Neurosurgery, Department of Surgery, Ćuprija General Hospital, Ćuprija, Serbia; 4Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 5Department of Neurosurgery, Kragujevac Clinical Center, Kragujevac, Serbia; 6Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; 7Neuroradiology Department, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 9University of Applied Health Sciences
| | - Filip Vitošević
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Section for Neurosurgery, Department of Surgery, Ćuprija General Hospital, Ćuprija, Serbia; 4Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 5Department of Neurosurgery, Kragujevac Clinical Center, Kragujevac, Serbia; 6Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; 7Neuroradiology Department, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 9University of Applied Health Sciences
| | - Nenad Novaković
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Section for Neurosurgery, Department of Surgery, Ćuprija General Hospital, Ćuprija, Serbia; 4Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 5Department of Neurosurgery, Kragujevac Clinical Center, Kragujevac, Serbia; 6Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; 7Neuroradiology Department, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 9University of Applied Health Sciences
| | - Miroslav Samardžić
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Section for Neurosurgery, Department of Surgery, Ćuprija General Hospital, Ćuprija, Serbia; 4Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 5Department of Neurosurgery, Kragujevac Clinical Center, Kragujevac, Serbia; 6Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; 7Neuroradiology Department, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 9University of Applied Health Sciences
| | - Krešimir Rotim
- 1Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia; 3Section for Neurosurgery, Department of Surgery, Ćuprija General Hospital, Ćuprija, Serbia; 4Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; 5Department of Neurosurgery, Kragujevac Clinical Center, Kragujevac, Serbia; 6Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; 7Neuroradiology Department, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia; 8Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 9University of Applied Health Sciences
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