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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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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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What is evidence based in the reconstruction of digital nerves? A systematic review. J Plast Reconstr Aesthet Surg 2013; 66:151-64. [DOI: 10.1016/j.bjps.2012.08.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 06/11/2012] [Accepted: 08/27/2012] [Indexed: 01/10/2023]
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Skin reference point for the zygomatic branch of the facial nerve innervating the orbicularis oculi muscle (anatomical study). Surg Radiol Anat 2012; 35:259-62. [DOI: 10.1007/s00276-012-1023-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 09/12/2012] [Indexed: 12/11/2022]
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Abstract
BACKGROUND Optimal surgical management of digital nerve lesions remains uncertain despite the publication of numerous studies. The purposes of this review were primarily to analyze whether there is a superior surgical technique for digital nerve repair and secondarily to statistically verify the variables to be predictors of sensory recovery. METHODS A literature search was performed using PubMed including citation from MEDLINE. Studies were included if they involved patients with digital nerve lacerations in whom end-to-end neurorrhaphy, nerve grafts, conduits, or end-to-side neurorrhaphy were performed. Further, the sensory outcome had to be assessed according to the modified American Society for Surgery of the Hand guidelines to stratify for two-point discrimination in millimeters. The variables age, follow-up, delay in repair, type of trauma, and gap length were extracted. The association between each predictor and response was assessed using a linear mixed model and corrected for heterogeneity between studies. Significance was considered present at p ≤ 0.05. RESULTS Of the 34 articles found, 14 articles were included giving appropriate individual data for 191 nerves. There was no statistically significant difference in outcome between operation techniques. Age and follow-up were verified predictors of sensory recovery. CONCLUSION In this review, the type of operation for digital nerve repair does not influence sensory outcome. However, we verified outcome to be influenced by the patient's age and the follow-up period. To add more scientific evidence to our results, larger cohort prospective studies need to be done with better detailed description of data.
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Abstract
The last 15 years have seen a growing interest regarding a technique for nerve repair named end-to-side coaptation. Since 2000, we have carried out experimental studies on end-to-side nerve repair as well as employed this technique to a series of selected clinical cases. Here we report on the results of this experience.For experimental studies, we have used the model represented by median nerve repair by end-to-side coaptation either on the ulnar (agonistic) or the radial (antagonistic) nerve. For time course assessment of median nerve functional recovery we used the grasping test, a test which permits to assess voluntary control of muscle function. Repaired nerves were processed for resin embedding to allow nerve fibre stereology and electron microscopy. Results showed that, in either experimental group, end-to-side-repaired median nerves were repopulated by axons regenerating from ulnar and radial donor nerves, respectively. Moreover, contrary to previously published data, our results showed that voluntary motor control of the muscles innervated by the median nerve was progressively recovered also when the antagonistic radial nerve was the donor nerve.As regards our clinical experience, results were not so positive. We have treated by end-to-side coaptation patients with both sensory (n = 7, collateral digital nerves) and mixed (n = 8, plexus level) nerve lesions. Results were good, as in other series, in sensory nerves whilst they were very difficult to investigate in mixed nerves at the plexus level.Take together, these results suggest that clinical employment of end-to-side coaptation should still be considered at the moment as the ultima ratio in cases in which no other repair technique can be attempted. Yet, it is clear that more basic research is needed to explain the reasons for the different results between laboratory animal and humans and, especially, to find out how to ameliorate the outcome of end-to-side nerve repair by adequate treatment and rehabilitation.
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Sleilati FH, Nasr MW, Stephan HA, Asmar ZD, Hokayem NE. Treating facial nerve palsy by true termino-lateral hypoglossal-facial nerve anastomosis. J Plast Reconstr Aesthet Surg 2010; 63:1807-12. [PMID: 20116357 DOI: 10.1016/j.bjps.2009.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 12/01/2009] [Accepted: 12/02/2009] [Indexed: 11/26/2022]
Abstract
Hypoglossal-facial nerve anastomosis is a time-proven technique for the repair of facial nerve palsy. Efforts have been made to reduce hypoglossal nerve injury, the main drawback of the technique. In this study, the anastomosis is a true termino-lateral neurorrhaphy with only an epineural window in the hypoglossal nerve sheath. A re-routing technique of the temporal facial nerve is also performed to allow a direct anastomosis to the hypoglossal nerve without the need for a jump graft. The first three results reported are very encouraging, with a satisfactory return of facial mimics and without any impairment of lingual function.
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Affiliation(s)
- F H Sleilati
- Plastic and Maxillofacial Surgery Department, Hôtel Dieu de France Hospital, Alfred Naccache Boulevard, Achrafieh, Lebanon.
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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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Bontioti E, Kanje M, Dahlin LB. End-to-side nerve repair: Attachment of a distal, compared with a proximal and distal, nerve segment. ACTA ACUST UNITED AC 2009; 40:129-35. [PMID: 16687331 DOI: 10.1080/02844310600574056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Regeneration occurs if a distal nerve segment is attached end-to-side to an intact donor nerve after the nerve has been injured. We investigated if attachment of a proximal nerve segment as well, as an extra source of axons, had any advantage over the single attachment of a distal nerve segment to the same donor nerve. In rats, a single distal radial nerve, or both the proximal and distal radial nerve segments, were attached end-to-side to the musculocutaneous nerve, and effects were examined up to eight months after the repair. Cell profiles were double-labelled, indicating recruitment of axons by collateral sprouting, but there were few such cells. There was a shift in the distribution of retrograde labelled neuronal cell profiles in spinal cord and in DRGs between the two types of repair. Both procedures resulted in axonal outgrowth and some functional recovery, but there was no improvement if a proximal nerve segment was also used as a source for axons.
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Affiliation(s)
- Eleana Bontioti
- Department of Hand Surgery, Malmö University Hospital, Malmö
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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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Lykissas MG, Korompilias AV, Batistatou AK, Mitsionis GI, Beris AE. Can end-to-side neurorrhaphy bridge large defects? An experimental study in rats. Muscle Nerve 2008; 36:664-71. [PMID: 17661375 DOI: 10.1002/mus.20861] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study was undertaken to evaluate collateral sprouting capability in an end-to-side repair model with long regenerative distance. Forty-five rats were used and divided into four groups, according to the reparative procedure following peroneal nerve division: (A) "double" end-to-side neurorrhaphy with a regenerative distance of 0.6 cm; (B) "double" end-to-side neurorrhaphy with a regenerative distance of 1.2 cm; (C) end-to-end neurorrhaphy; and (D) nerve stumps buried into neighboring muscles. In all animals the contralateral healthy side served as a control. Functional assessment of nerve regeneration was performed at intervals up to 5 months using the Peroneal Function Index (PFI). Evaluation 150 days after surgery included peroneal and tibial nerve histologic and morphometric examination and wet weights of the tibialis anterior muscle. Functional evaluation and axonal counting data demonstrated that there was no statistically significant difference between groups A and B, or between groups A and C. There was no functional or histologic evidence of donor nerve deterioration. In conclusion, the present study confirms that "double" end-to-side neurorrhaphy may be useful for the repair of divided human nerves with long gaps.
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Affiliation(s)
- Marios G Lykissas
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, P.C. 45110, Greece.
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Beris A, Lykissas M, Korompilias A, Mitsionis G. End-to-Side Nerve Repair in Peripheral Nerve Injury. J Neurotrauma 2007; 24:909-16. [PMID: 17518544 DOI: 10.1089/neu.2006.0165] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
In peripheral nerve injury, end-to-side neurorrhaphy has been reported as an alternative in cases that the proximal nerve stump is not accessible. Several hypotheses have been proposed to explain peripheral nerve regeneration after end-to-side neurorrhaphy. Recent evidence suggests that nerve regeneration occurs by collateral sprouting. Although a great number of humoral factors have been identified, molecular mechanism of nerve regeneration after end-to-side neurorrhaphy has not been completely clarified yet. The goal of this technique is to provide satisfactory functional recovery for the recipient nerve, without any deterioration of the donor nerve function. End-to-side technique has been investigated in detail in both experimental and clinical studies. Only a limited number of reported cases in clinical practice, until today, can reveal that end-to-side technique may become a viable means of repairing peripheral nerves in certain clinical situations.
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Affiliation(s)
- Alexandros Beris
- Department of Orthopaedics, University of Ioannina, Ioannina, Greece.
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Kelly EJ, Jacoby C, Terenghi G, Mennen U, Ljungberg C, Wiberg M. End-to-side nerve coaptation: a qualitative and quantitative assessment in the primate. J Plast Reconstr Aesthet Surg 2006; 60:1-12. [PMID: 17126261 DOI: 10.1016/j.bjps.2005.12.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Revised: 11/30/2005] [Accepted: 12/09/2005] [Indexed: 11/28/2022]
Abstract
There are several reasons why end-to-side nerve coaptation has not been widely adopted clinically. Among these are the putative damage inflicted on the donor nerve and the variable quality of the regeneration in the recipient nerve. So far experiments on end-to-side nerve repair have been short term and mostly carried out on rats. This long-term study of end-to-side nerve repair of ulnar to median and median to ulnar nerve was performed using adult nonhuman primates. Eleven nerve repairs were studied at different time points. Eighteen, 22, 33 and 57 months after surgery a qualitative and quantitative analysis of the donor nerve and regenerating nerve revealed variable levels of percentage axonal regeneration compared with matched controls (1.4%-136%). Morphological evidence of donor nerve damage was identified distal to the coaptation site in four of the 11 cases, and in these cases the best axonal regeneration in the corresponding recipient nerves was observed. This donor nerve damage could neither be demonstrated in terms of a decrease in axon counts distal to the coaptation nor as donor target organ denervation. Recipient target organ regeneration like the axonal regeneration varied, with evidence of motor regeneration in eight out of 11 cases and sensory regeneration, as measured by percentage innervation density compared with matched controls, varied from 12.5% to 49%. Results from the present study demonstrate that the end-to-side coaptation technique in the nonhuman primate does not give predictable results. In general the motor recovery appeared better than the sensory and in those cases where donor nerve damage was observed there was better motor and sensory regeneration overall than in the remaining cases.
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Affiliation(s)
- E J Kelly
- Department of Anatomy, Umeå University, Umeå, Sweden; Department of Hand and Plastic Surgery, Umeå University, Umeå, Sweden
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15
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Eren F, Yuksel F, Ulkur E, Cavdar S, Ercan F, Celikoz B. Nerve Regeneration through a Healthy Nerve Trunk: A New and Hopeful Conduit for Bridging Nerve Defects. Plast Reconstr Surg 2005; 116:1697-705. [PMID: 16267434 DOI: 10.1097/01.prs.0000186538.04622.7a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Considering a healthy nerve trunk as the hypothetically ideal conduit, a new experimental model using an intact nerve for bridging a nerve defect was contemplated. METHODS Thirty rats were used. In group I (double coaptation), a segment was removed from the peroneal nerve. Both the proximal and distal stumps were repaired end-to-side to the tibial nerve. In group II (only distal coaptation), only the distal nerve stump was repaired. In group III (control), the transected segment was immediately repaired primarily in its original orientation as a nerve graft. A walking track analysis was conducted periodically for 28 months. The horseradish peroxidase retrograde labeling technique was used for tracking the origin of the axons presented in the distal stump of the peroneal nerve in group I, and morphologic studies were also carried out for all the groups. RESULTS Functional assessment revealed that the difference between group I and group II was significant. The horseradish peroxidase labeling test suggested that the nerve fibers in the distal stump of the peroneal nerve were mostly from its original proximal stump passed by the way of the tibial nerve bridge. CONCLUSION This study suggested that the axons of the proximal stump of a sectioned nerve can sprout into another intact nerve trunk by the way of an end-to-side repair site, regenerate, and advance in its epineurium distally for a distance and pass into its original distal stump if it was repaired end-to-side. It was thought that the technique could be used in clinical cases with short nerve defects as an alternative method to grafts and conduits.
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Affiliation(s)
- Fikret Eren
- Department of Plastic and Reconstructive Surgery, Gülhane Military Medical Academy, Haydarpasa Hospital, Istanbul, Turkey
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Voche P. Notre expérience de dix sutures latéroterminales de nerfs sensitifs de la main. ANN CHIR PLAST ESTH 2005; 50:264-9. [PMID: 15878226 DOI: 10.1016/j.anplas.2005.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Accepted: 03/08/2005] [Indexed: 11/25/2022]
Abstract
Ten traumatic nerve defects at the palm or digit level were treated by end-to-side (ETS) neurorrhaphy. The technique included removal of an epineurial window on the donor nerve and coaptation of the sharply cut distal end of the injured nerve by epineurial stitches under microscope magnification. At final follow-up, the static two-point discrimination test scored at an average of 9.1 (range, 6-12) mm on the repaired nerve, compared to an average of 4.6 (range, 4-6) mm on the contralateral uninjured control side. The moving two-point discrimination test scored at an average of 7 (range, 4-10) mm on the repaired nerve compared to an average of 2.6 (range, 2-4) mm on the control side. This short series showed ETS neurorrhaphies are effective and give comparable results with those of nerve grafts or vein conduits, but worse than direct repairs.
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Affiliation(s)
- P Voche
- Clinique La-Francilienne, Pontault-Combault, France.
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Voche P, Ouattara D. End-to-side neurorrhaphy for defects of palmar sensory digital nerves. ACTA ACUST UNITED AC 2005; 58:239-44. [PMID: 15710121 DOI: 10.1016/j.bjps.2004.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2003] [Revised: 05/28/2004] [Accepted: 06/03/2004] [Indexed: 12/25/2022]
Abstract
Ten traumatic nerve defects at the palm or digit level were treated by end-to-side (ETS) neurorrhaphy. The technique included removal of an epineurial window on the donor nerve and coaptation of the sharply cut distal end of the injured nerve by epineurial stitches under microscopic magnification. At final follow-up, the static two-point discrimination test (2 pd) scored at an average of 9.1 mm (range, 6-12 mm) on the repaired nerve, compared to an average of 4.6 mm (range, 4-6 mm) on the contralateral uninjured control side. Moving 2 pd scored at an average of 7 mm (range, 4-9 mm) on the repaired nerve compared to an average of 2.6 mm (range, 2-4 mm) on the control side. This short series showed that ETS neurorrhaphies are effective and give comparable results with those of nerve grafts or vein conduits.
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Affiliation(s)
- P Voche
- Department of Hand and Upper Extremity Reconstructive Surgery, Clinique La Francilienne, 16 Avenue de l'hôtel de ville, 77340 Pontault-Combault, France.
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