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Serra PL, Giannaccare G, Cuccu A, Bolognesi F, Biglioli F, Marcasciano M, Tarabbia F, Pagliara D, Figus A, Boriani F. Insights on the Choice and Preparation of the Donor Nerve in Corneal Neurotization for Neurotrophic Keratopathy: A Narrative Review. J Clin Med 2024; 13:2268. [PMID: 38673540 PMCID: PMC11050919 DOI: 10.3390/jcm13082268] [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: 02/27/2024] [Revised: 03/28/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
The article introduces neurotrophic keratopathy (NK), a condition resulting from corneal denervation due to various causes of trigeminal nerve dysfunctions. Surgical techniques for corneal neurotization (CN) have evolved, aiming to restore corneal sensitivity. Initially proposed in 1972, modern approaches offer less invasive options. CN can be performed through a direct approach (DCN) directly suturing a sensitive nerve to the affected cornea or indirectly (ICN) through a nerve auto/allograft. Surgical success relies on meticulous donor nerve selection and preparation, often involving multidisciplinary teams. A PubMed research and review of the relevant literature was conducted regarding the surgical approach, emphasizing surgical techniques and the choice of the donor nerve. The latter considers factors like sensory integrity and proximity to the cornea. The most used are the contralateral or ipsilateral supratrochlear (STN), and the supraorbital (SON) and great auricular (GAN) nerves. Regarding the choice of grafts, the most used in the literature are the sural (SN), the lateral antebrachial cutaneous nerve (LABCN), and the GAN nerves. Another promising option is represented by allografts (acellularized nerves from cadavers). The significance of sensory recovery and factors influencing surgical outcomes, including nerve caliber matching and axonal regeneration, are discussed. Future directions emphasize less invasive techniques and the potential of acellular nerve allografts. In conclusion, CN represents a promising avenue in the treatment of NK, offering tailored approaches based on patient history and surgical expertise, with new emerging techniques warranting further exploration through basic science refinements and clinical trials.
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Affiliation(s)
- Pietro Luciano Serra
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari University Hospital Trust, 07100 Sassari, Italy;
- Plastic Surgery and Microsurgery Unit, Department of Surgical Sciences, Faculty of Medicine and Surgery, University Hospital “Duilio Casula”, University of Cagliari, 09124 Cagliari, Italy; (A.F.); (F.B.)
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy;
| | - Alberto Cuccu
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy;
| | - Federico Bolognesi
- Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital, University of Milan, 20122 Milan, Italy; (F.B.); (F.B.); (F.T.)
| | - Federico Biglioli
- Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital, University of Milan, 20122 Milan, Italy; (F.B.); (F.B.); (F.T.)
| | - Marco Marcasciano
- Plastic and Reconstructive Surgery Unit, Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
- Unit of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Filippo Tarabbia
- Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital, University of Milan, 20122 Milan, Italy; (F.B.); (F.B.); (F.T.)
| | - Domenico Pagliara
- Plastic-Reconstructive and Lymphedema Microsurgery Center, Mater Olbia Hospital, 07026 Olbia, Italy;
| | - Andrea Figus
- Plastic Surgery and Microsurgery Unit, Department of Surgical Sciences, Faculty of Medicine and Surgery, University Hospital “Duilio Casula”, University of Cagliari, 09124 Cagliari, Italy; (A.F.); (F.B.)
| | - Filippo Boriani
- Plastic Surgery and Microsurgery Unit, Department of Surgical Sciences, Faculty of Medicine and Surgery, University Hospital “Duilio Casula”, University of Cagliari, 09124 Cagliari, Italy; (A.F.); (F.B.)
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Braga Silva J, Busnello CV, Becker AS, Moriguchi CA, de Melo RO, Waichel VB. End-to-side neurorrhaphy in peripheral nerves: Does it work? HAND SURGERY & REHABILITATION 2021; 41:2-6. [PMID: 34464758 DOI: 10.1016/j.hansur.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/05/2021] [Accepted: 08/21/2021] [Indexed: 11/15/2022]
Abstract
Acute peripheral nerve injuries are common and can cause physical disabilities with sensory and functional sequelae; they therefore require surgery. The aim of this study was to conduct a systematic review to assess the clinical applicability of end-to-side neurorrhaphy in peripheral nerve reconstruction, based on available evidence. We carried out a systematic review of the literature using MEDLINE/PubMed, EMBASE, Cochrane Library, Web of Science, Scielo and Scopus through March 16, 2021. Most of the selected studies were qualitative and employed nonrandomized groups of patients, without standardized scales for assessing outcomes, which made statistical analysis difficult. Efficacy varied from 24% to 81%. Factors for better outcome included the type of injury, type of injured nerve (sensory, motor or mixed), presence of an epineural window, topography, injury extension <1.3 cm, and intervention within 2 weeks of injury. Clinical studies so far lack scientific evidence on end-to-side neurorrhaphy in peripheral nerve lesions.
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Affiliation(s)
- J Braga Silva
- Service of Hand Surgery and Reconstructive Microsurgery, São Lucas Hospital, Centro Clinico PUCRS, Av. Ipiranga 6690, Suite 216, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil.
| | - C V Busnello
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil.
| | - A S Becker
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil.
| | - C A Moriguchi
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil.
| | - R O de Melo
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil.
| | - V B Waichel
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, 90610-000 Porto Alegre, Rio Grande do Sul, Brazil.
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Liu CY, Arteaga AC, Fung SE, Cortina MS, Leyngold IM, Aakalu VK. Corneal neurotization for neurotrophic keratopathy: Review of surgical techniques and outcomes. Ocul Surf 2021; 20:163-172. [PMID: 33647470 PMCID: PMC8113161 DOI: 10.1016/j.jtos.2021.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
Neurotrophic keratopathy is a degenerative disease in which damage to the corneal nerves leads to corneal hypoesthesia. Injuries to neurotrophic corneas are notoriously difficult to treat and have traditionally been approached with supportive management. However, recent progress in the field of corneal neurotization has given new direction for addressing nerve loss directly by stimulating new nerve growth onto the cornea from nearby sensory nerves transferred to the perilimbal region. Herein, we review the surgical techniques utilized in corneal neurotization, including direct transfers and the use of nerve grafts. Considerations in surgical approach, as well as factors that influence prognosis and outcomes of the surgical intervention are also discussed.
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Affiliation(s)
- Catherine Y Liu
- Viterbi Family Department of Ophthalmology, UC San Diego, San Diego, CA, USA.
| | - Andrea C Arteaga
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Sammie E Fung
- Viterbi Family Department of Ophthalmology, UC San Diego, San Diego, CA, USA
| | - M Soledad Cortina
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Ilya M Leyngold
- Duke University Medical Center, Department of Ophthalmology, Durham, NC, USA
| | - Vinay K Aakalu
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
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Tognon-Miguel V, Nascimento-Elias AH, Schiavoni MCL, Barreira AA. Plasticity of Unmyelinated Fibers in a Side-to-end Tubulization Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e1993. [PMID: 30859022 PMCID: PMC6382236 DOI: 10.1097/gox.0000000000001993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Histomorphometric studies of unmyelinated fibers of the rat fibular nerves are uncommon, and side-to-end neurorrhaphy studies using the fibular nerve investigate primarily motor fibers. We investigated side-to-end tubulization (SET) technique, in which occurs collateral sprouting from the intact donor nerve fibers to the distal stump of receptor nerve, with muscle reinnervation and functional rehabilitation, to assess whether there is a successful growth of unmyelinated fibers in this model. METHODS Adult Wistar rats fibular nerves were sectioned to create a 5-mm gap. A 6-mm silicone tube was attached between a side of the intact tibial nerve and the sectioned fibular nerve distal stump (SET group), with the left fibular nerve as normal (sham group). Seventy days postsurgery, unmyelinated fibers from the distal segment of the fibular nerve were quantified using light and transmission electron microscopy and their diameters were measured. RESULTS The number of unmyelinated fibers was similar between sham (1,882 ± 270.9) and SET (2,012 ± 1,060.8), but axons density was significantly greater in the SET (18,733.3 ± 5,668.6) than sham (13,935.0 ± 1,875.8). Additionally, the axonal diameters differed significantly between groups with mean measures in sham (0.968 ± 0.10) > SET (0.648 ± 0.08). CONCLUSIONS Unmyelinated fiber growth occurred even with a 5-mm distance between the donor and receptor nerves, reaching similar axonal number to the normal nerve, demonstrating that the SET is a reliable technique that can promote a remarkable plasticity of unmyelinated axons.
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Affiliation(s)
- Vânia Tognon-Miguel
- Department of Neurosciences and Behavioral Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Adriana H Nascimento-Elias
- Department of Neurosciences and Behavioral Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Maria C L Schiavoni
- Department of Neurosciences and Behavioral Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Amilton A Barreira
- Department of Neurosciences and Behavioral Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Emamhadi M, Andalib S. Successful recovery of sensation loss in upper brachial plexus injuries. Acta Neurochir (Wien) 2018; 160:2019-2023. [PMID: 30094689 DOI: 10.1007/s00701-018-3648-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/31/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Injuries of the upper trunk of the brachial plexus may trigger motor and sensory deficits. There exists a growing body of literature with respect to the reconstruction of motor deficits in upper trunk brachial plexus injuries by using nerve transfers; albeit to date, very few old reports have focused on the reconstruction of sensory loss resulting from upper trunk injuries. In this case series, we review six cases (five males and one female) with upper trunk brachial plexus injuries undergoing sensory nerve transfers. METHODS Sensory reconstruction was carried out by using transfer of the ulnar to the median nerves, innervating adjacent aspects of the little and ring fingers (the fourth web space) and adjacent aspects of the thumb and the index finger (the first web space), respectively. RESULTS The mean age of our six patients was 30.5 ± 9 years old (range 20-45). The mean time interval between the injury and subsequent surgery was 6.6 ± 1.8 months (range 5-10). Five patients achieved S3 or S3+ in both the thumb and the index finger while the sixth one regained S2+ in the index finger while also achieving S3 in the thumb according to the Highet-Zachary system scoring scale. CONCLUSION These results suggest that nerve transfers can achieve satisfactory outcomes in patients having sensory reconstruction after upper brachial plexus injuries, and thus, we lay emphasis on reviving the use of sensory nerve transfer techniques in such patients.
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Pomares G, Dap F, Dautel G. Results of primary end-to-side digital nerve neurorrhaphy in eight patients. J Hand Surg Eur Vol 2017; 42:861-863. [PMID: 28490263 DOI: 10.1177/1753193417695177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- G Pomares
- Service de chirurgie plastique, et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile Gallé, Nancy, France
| | - F Dap
- Service de chirurgie plastique, et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile Gallé, Nancy, France
| | - G Dautel
- Service de chirurgie plastique, et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile Gallé, Nancy, France
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Geuna S, Papalia I, Ronchi G, d'Alcontres FS, Natsis K, Papadopulos NA, Colonna MR. The reasons for end-to-side coaptation: how does lateral axon sprouting work? Neural Regen Res 2017; 12:529-533. [PMID: 28553322 PMCID: PMC5436340 DOI: 10.4103/1673-5374.205081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Nerve fibers are attracted by sutureless end-to-side nerve coaptation into the recipient nerve. Opening a window in the epineurium enhances axon attraction and myelination. The authors analyze the features of nerve repair by end-to-side coaptation. They highlight the known mechanisms of axon sprouting and different hypotheses of start up signals (presence or absence of an epineurial window, role of Schwann cells, signaling from the distal trunk). The clinical literature is also presented and differences between experimental and clinical applications are pointed out. The authors propose their point of view and perspectives deriving from recent experimental and clinical experiences.
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Affiliation(s)
- Stefano Geuna
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Igor Papalia
- Department of Biomedical and Dental Sciences and Morphological and Functional Sciences, University of Messina, Messina, Italy
| | - Giulia Ronchi
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Francesco Stagno d'Alcontres
- Department of Human Pathology of the Adults, the Children and the Adolescents, University of Messina, Messina, Italy
| | - Konstantinos Natsis
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, Aristoteles University, Thessaloniki, Greece
| | - Nikolaos A Papadopulos
- Department of Plastic Surgery and Burns, Alexandroupoli University General Hospital, Democritus University of Thrace, Alexandroupoli, Greece
| | - Michele R Colonna
- Department of Human Pathology of the Adults, the Children and the Adolescents, University of Messina, Messina, Italy
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Papalia I, Magaudda L, Righi M, Ronchi G, Viano N, Geuna S, Colonna MR. Epineurial Window Is More Efficient in Attracting Axons than Simple Coaptation in a Sutureless (Cyanoacrylate-Bound) Model of End-to-Side Nerve Repair in the Rat Upper Limb: Functional and Morphometric Evidences and Review of the Literature. PLoS One 2016; 11:e0148443. [PMID: 26872263 PMCID: PMC4752340 DOI: 10.1371/journal.pone.0148443] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/18/2016] [Indexed: 12/27/2022] Open
Abstract
End-to-side nerve coaptation brings regenerating axons from the donor to the recipient nerve. Several techniques have been used to perform coaptation: microsurgical sutures with and without opening a window into the epi(peri)neurial connective tissue; among these, window techniques have been proven more effective in inducing axonal regeneration. The authors developed a sutureless model of end-to-side coaptation in the rat upper limb. In 19 adult Wistar rats, the median and the ulnar nerves of the left arm were approached from the axillary region, the median nerve transected and the proximal stump sutured to the pectoral muscle to prevent regeneration. Animals were then randomly divided in two experimental groups (7 animals each, 5 animals acting as control): Group 1: the distal stump of the transected median nerve was fixed to the ulnar nerve by applying cyanoacrylate solution; Group 2: a small epineurial window was opened into the epineurium of the ulnar nerve, caring to avoid damage to the nerve fibres; the distal stump of the transected median nerve was then fixed to the ulnar nerve by applying cyanoacrylate solution. The grasping test for functional evaluation was repeated every 10-11 weeks starting from week-15, up to the sacrifice (week 36). At week 36, the animals were sacrificed and the regenerated nerves harvested and processed for morphological investigations (high-resolution light microscopy as well as stereological and morphometrical analysis). This study shows that a) cyanoacrylate in end-to-side coaptation produces scarless axon regeneration without toxic effects; b) axonal regeneration and myelination occur even without opening an epineurial window, but c) the window is related to a larger number of regenerating fibres, especially myelinated and mature, and better functional outcomes.
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Affiliation(s)
- Igor Papalia
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Ludovico Magaudda
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Maria Righi
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Giulia Ronchi
- Department of Clinical and Biological Sciences, University of Torino, Orbassano (Torino), Italy
- Neuroscience Institute of the “Cavalieri Ottolenghi” Foundation (NICO), University of Torino, Orbassano (Torino), Italy
| | - Nicoletta Viano
- Department of Clinical and Biological Sciences, University of Torino, Orbassano (Torino), Italy
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, University of Torino, Orbassano (Torino), Italy
- Neuroscience Institute of the “Cavalieri Ottolenghi” Foundation (NICO), University of Torino, Orbassano (Torino), Italy
- * E-mail:
| | - Michele Rosario Colonna
- Department of Experimental and Clinical Surgical and Medical Specialties, University of Messina, Messina, Italy
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Clinical applications of end-to-side neurorrhaphy: an update. BIOMED RESEARCH INTERNATIONAL 2014; 2014:646128. [PMID: 25136607 PMCID: PMC4127263 DOI: 10.1155/2014/646128] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/14/2014] [Accepted: 07/07/2014] [Indexed: 01/16/2023]
Abstract
End-to-side neurorrhaphy constitutes an interesting option to regain nerve function after damage in selected cases, in which conventional techniques are not feasible. In the last twenty years, many experimental and clinical studies have been conducted in order to understand the biological mechanisms and to test the effectiveness of this technique, with contrasting results. In this updated review, we consider the state of the art about end-to-side coaptation, focusing on all the current clinical applications, such as sensory and mixed nerve repair, treatment of facial palsy, and brachial plexus injuries and painful neuromas management.
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Sensory recovery outcome after digital nerve repair in relation to different reconstructive techniques: meta-analysis and systematic review. PLASTIC SURGERY INTERNATIONAL 2013; 2013:704589. [PMID: 23984064 PMCID: PMC3745965 DOI: 10.1155/2013/704589] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/30/2013] [Indexed: 11/17/2022]
Abstract
Good clinical outcome after digital nerve repair is highly relevant for proper hand function and has a significant socioeconomic impact. However, level of evidence for competing surgical techniques is low. The aim is to summarize and compare the outcomes of digital nerve repair with different methods (end-to-end and end-to-side coaptations, nerve grafts, artificial conduit-, vein-, muscle, and muscle-in-vein reconstructions, and replantations) to provide an aid for choosing an individual technique of nerve reconstruction and to create reference values of standard repair for nonrandomized clinical studies. 87 publications including 2,997 nerve repairs were suitable for a precise evaluation. For digital nerve repairs there was practically no particular technique superior to another. Only end-to-side coaptation had an inferior two-point discrimination in comparison to end-to-end coaptation or nerve grafting. Furthermore, this meta-analysis showed that youth was associated with an improved sensory recovery outcome in patients who underwent digital replantation. For end-to-end coaptations, recent publications had significantly better sensory recovery outcomes than older ones. Given minor differences in outcome, the main criteria in choosing an adequate surgical technique should be gap length and donor site morbidity caused by graft material harvesting. Our clinical experience was used to provide a decision tree for digital nerve repair.
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Artiaco S, Tos P, Conforti LG, Geuna S, Battiston B. Termino-lateral nerve suture in lesions of the digital nerves: clinical experience and literature review. J Hand Surg Eur Vol 2010; 35:109-14. [PMID: 19687081 DOI: 10.1177/1753193409337959] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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 termino-lateral 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 S3+ 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, S3+ 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, end-to-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.
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Affiliation(s)
- S Artiaco
- UOD di Microchirurgia Ricostruttiva, Dipartimento di Ortopedia e Traumatologia A.O. CTO-M.Adelaide, Torino, Italy
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Tos P, Artiaco S, Papalia I, Marcoccio I, Geuna S, Battiston B. Chapter 14 End‐to‐Side Nerve Regeneration. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:281-94. [DOI: 10.1016/s0074-7742(09)87014-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
To bring some light into the ongoing controversy concerning end-to-side coaptation in brachial plexus surgery, the authors organized a symposium in 2006 titled How To Improve Peripheral Nerve Surgery. The authors sought the participation of experienced surgeons and researchers who had made personal contributions to the field. This article contains information collected at this symposium and presents the authors' clinical results and ideas illustrating the potential of nerve fiber transfer by end-to-side coaptation.
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Affiliation(s)
- Hanno Millesi
- Millesi Center, Vienna Private Clinic, Pelikangasse 15, A-1090 Vienna, Austria.
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Surgical rehabilitation of reversible facial palsy: Facial–hypoglossal network system based on neural signal augmentation/neural supercharge concept. J Plast Reconstr Aesthet Surg 2007; 60:223-31. [DOI: 10.1016/j.bjps.2006.05.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 04/30/2006] [Accepted: 05/31/2006] [Indexed: 11/20/2022]
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Frey M, Giovanoli P, Michaelidou M. Functional upgrading of partially recovered facial palsy by cross-face nerve grafting with distal end-to-side neurorrhaphy. Plast Reconstr Surg 2006; 117:597-608. [PMID: 16462346 DOI: 10.1097/01.prs.0000197136.56749.c6] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cross-face nerve grafting combined with functional muscle transplantation has become the standard in reconstructing an emotionally controlled smile in complete irreversible facial palsy. A special problem exists in incomplete or partially recovered facial palsies, when the little existing function should be preserved but the existing function alone is clinically insufficient. METHODS In this situation, cross-face nerve grafting performed by means of end-to-end coaptation to a zygomatic branch of the healthy side and by end-to-side neurorrhaphy to a corresponding branch of the incompletely paralyzed side is proposed to upgrade smile function on the latter side and contribute to more static and dynamic overall symmetry. The interposition nerve graft is set in overlength to preserve the possibility of a later muscle transplantation in case of unsatisfying functional result through the additional neuronal input. The authors have used this concept in seven patients with irreversible partial facial palsy. Three cases have a sufficiently long follow-up to be presented here. Outcome was objectively quantified with three-dimensional video analysis of facial movements. RESULTS In all three cases, functional improvement and a positive effect on the static and dynamic symmetry of the face could be measured. None of the patients was disappointed by the smile function achieved or wanted to undergo additional muscle transplantation. CONCLUSION On the basis of these first clinical experiences, the authors recommend cross-face nerve grafting with overlength and a distal end-to-side neurorrhaphy in patients with irreversible incomplete facial palsy affecting the smile.
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Affiliation(s)
- Manfred Frey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
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