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Alare K, Salam T, Abioye E, Utah F, Balogun O, Adedokun P, Moradeyo A, Adeniran-Yusuf A, Soyinka E, Egbo C, Alao A. The outcomes of peripheral nerve surgeries in Africa: Narrative synthesis from existing literature. Clin Neurol Neurosurg 2024; 244:108419. [PMID: 38986367 DOI: 10.1016/j.clineuro.2024.108419] [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: 05/22/2024] [Revised: 06/29/2024] [Accepted: 06/30/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND In Africa, peripheral nerve pathologies are a major source of disability, and the results of surgical therapies differ greatly among countries. The goal of this narrative review is to compile the most recent data on peripheral nerve surgery results in Africa, pinpoint critical variables that affect surgical outcomes, and offer suggestions for enhancing patient care. METHODS A comprehensive literature review was conducted, focusing on studies published over the past four decades. The sources included peer-reviewed journals, hospital records, and reports from healthcare organizations. The review examined outcomes related to functional recovery, quality of life, and postoperative complications. RESULTS The outcomes of peripheral nerve surgeries in Africa are influenced by the availability of medical infrastructure, the level of surgeon expertise, and the timeliness of the intervention. Urban centers with better resources tend to report more favorable outcomes, whereas rural areas face significant challenges. Common barriers include limited access to advanced surgical tools, a shortage of specialized surgeons, and inadequate postoperative care and rehabilitation services. Despite these challenges, successful interventions have been reported, particularly in settings where targeted training programs and international collaborations are in place. CONCLUSION Enhancing surgeon training programs, building comprehensive postoperative care and rehabilitation facilities, and investing in healthcare infrastructure are critical to improving peripheral nerve surgery results in Africa. International and regional collaborations can be extremely helpful in advancing these initiatives by enabling the sharing of knowledge and granting access to cutting-edge methods. Patients with peripheral nerve injuries across the continent may experience improved functional recovery and overall quality of life if these criteria are met.
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Affiliation(s)
- Kehinde Alare
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
| | - Temiloluwa Salam
- Department of Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Elishama Abioye
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Francisca Utah
- Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Opeyemi Balogun
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Precious Adedokun
- Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria
| | - Abdulrahmon Moradeyo
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | | | | | | | - Adedoyin Alao
- Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Lin JS, Jain SA. Challenges in Nerve Repair and Reconstruction. Hand Clin 2023; 39:403-415. [PMID: 37453767 DOI: 10.1016/j.hcl.2023.05.001] [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] [Indexed: 07/18/2023]
Abstract
Peripheral nerve injuries may substantially impair a patient's function and quality of life. Despite appropriate treatment, outcomes often remain poor. Direct repair remains the standard of care when repair is possible without excessive tension. For larger nerve defects, nerve autografting is the gold standard. However, a considerable challenge is donor site morbidity. Processed nerve allografts and conduits are other options, but evidence supporting their use is limited to smaller nerves and shorter gaps. Nerve transfer is another technique that has seen increasing popularity. The future of care may include novel biologics and pharmacologic therapy to enhance regeneration.
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Affiliation(s)
- James S Lin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, 241 West 11th Avenue, Suite 6081, Columbus, OH 43201, USA
| | - Sonu A Jain
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, 3rd Floor, Suite 3200, Columbus, OH 43212, USA.
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Garg V, Regmi A, Negi NK, Yasam R, Sinha SK, Singh V. Distal Nerve Transfer to Restore Wrist and Finger Extension - A Systematic Review. J Hand Surg Asian Pac Vol 2022; 27:1000-1007. [PMID: 36550081 DOI: 10.1142/s2424835522500953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: There are numerous options available for restoration of wrist and finger extension following radial nerve palsy. The aim of this study is to conduct a systematic review of the effectiveness of nerve transfer for radial nerve palsy. Methods: Electronic literature research of PubMed, Cochrane, Scopus and Lilacs database was conducted in June 2021 using the terms 'Distal nerve transfer' AND 'Radial nerve injury' 'Radial nerve palsy' OR 'Radial nerve paresis' OR 'Median nerve transfer' OR 'wrist extensor' OR 'finger extension' OR 'thumb extension' OR 'wrist motion'. The data extracted included the study details, demographic data, procedure performed and final functional outcome according to the muscle research council scale. Results: A total of 92.59% and 56.52% had satisfactory outcome following distal nerve transfer of median nerve to restore wrist and finger extension respectively. No significant correlation was found between time to injury duration and satisfactory outcomes. Conclusions: Outcomes of nerve transfers are comparable to tendon transfers. Multi-centric studies are needed to compare the results amongst various surgical procedures described. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Varun Garg
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
| | - Anil Regmi
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
| | | | - Ramapriya Yasam
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
| | | | - Vivek Singh
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
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Armas-Salazar A, García-Jerónimo AI, Villegas-López FA, Navarro-Olvera JL, Carrillo-Ruiz JD. Clinical outcomes report in different brachial plexus injury surgeries: a systematic review. Neurosurg Rev 2021; 45:411-419. [PMID: 34142268 DOI: 10.1007/s10143-021-01574-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/30/2021] [Accepted: 05/26/2021] [Indexed: 01/20/2023]
Abstract
Brachial plexus injury is a lesion that results in loss of function of the arm, and there are multiple ways of surgically approaching its treatment. Controlled trials that compare all surgical repair strategies and their clinical outcomes have not been performed. A systematic review was conducted to identify all articles that reported clinical outcomes in different surgeries (nerve transfer, nerve graft, neurolysis, end-to-end, multiple interventions, and others). Advanced search in PubMed was performed using the Mesh terms "brachial plexus injury" as the main topic and "surgery" as a subtopic, obtaining a total of 2153 articles. The clinical data for eligibility extraction was focused on collecting motor, sensory, pain, and functional recovery. A statistical analysis was performed to find the superior surgical techniques in terms of motor recovery, through the assessment of heterogeneity between groups, and of relationships between surgery and motor recovery. The frequency and the manner in which clinical outcomes are recording were described. The differences that correspond to the demographics and procedural factors were not statistically significant among groups (p > 0.05). Neurolysis showed the highest proportion of motor recovery (85.18%), with significant results between preoperative and post-operative motor assessment (p = 0.028). The proportion of motor recovery in each group according to the surgical approach differed significantly (X2 = 82.495, p = 0.0001). The motor outcome was the most reported clinical outcome (97.56%), whereas the other clinical outcomes were reported in less than 15% of the included articles. Unexpectedly, neurolysis, a technique displaced by new surgical alternatives such as nerve transfer/graft, demonstrated the highest proportion of motor recovery. Clinical outcomes such as pain, sensory, and functional recovery were infrequently reported. These results introduce the need to re-evaluate neurolysis through comparative clinical trials, as well as to standardize the way in which clinical outcomes are reported.
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Affiliation(s)
- A Armas-Salazar
- Mexican Faculty of Medicine, La Salle University, Mexico City, Mexico
- Functional & Stereotactic Neurosurgery & Radiosurgery Service, General Hospital of Mexico, Doctor Balmis 148 Doctores, México City, 06720, México
| | - A I García-Jerónimo
- Functional & Stereotactic Neurosurgery & Radiosurgery Service, General Hospital of Mexico, Doctor Balmis 148 Doctores, México City, 06720, México
| | - F A Villegas-López
- Functional & Stereotactic Neurosurgery & Radiosurgery Service, General Hospital of Mexico, Doctor Balmis 148 Doctores, México City, 06720, México
| | - J L Navarro-Olvera
- Functional & Stereotactic Neurosurgery & Radiosurgery Service, General Hospital of Mexico, Doctor Balmis 148 Doctores, México City, 06720, México
| | - J D Carrillo-Ruiz
- Functional & Stereotactic Neurosurgery & Radiosurgery Service, General Hospital of Mexico, Doctor Balmis 148 Doctores, México City, 06720, México.
- Research Direction of General Hospital of Mexico, Mexico City, Mexico.
- Faculty of Health Sciences Direction, of Anahuac University Mexico, Mexico City, Mexico.
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Bertelli JA, Nehete S, Winkelmann Duarte EC, Ghizoni MF. Transfer of the Distal Anterior Interosseous Nerve for Thumb Motion Reconstruction in Radial Nerve Paralysis. J Hand Surg Am 2020; 45:877.e1-877.e10. [PMID: 32209268 DOI: 10.1016/j.jhsa.2020.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 12/30/2019] [Accepted: 02/11/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE With nerve or tendon surgery, the results of thumb reconstruction to treat radial nerve paralysis are suboptimal. The goals of this study were to describe the anatomy of the deep branch of the posterior interosseous nerve (PIN) to the thumb extensor muscles (DBPIN), and to report the clinical results of transferring the distal anterior interosseous nerve (DAIN) to the DBPIN. METHODS The PIN was dissected in 12 fresh upper limbs. Myelinated nerve fibers in the DBPIN and DAIN were counted. Five patients with radial nerve paralysis underwent transfer of the motor branch to the flexor carpi radialis to the PIN and a motor branch of the pronator teres to the extensor carpi radialis brevis. In addition, these patients had selective reconstruction of thumb motion by transferring the DAIN to the DBPIN, through either a combined volar and dorsal approach (n = 2) or a single dorsal approach (n = 3) with division of the interosseous membrane. RESULTS At the origin of the abductor pollicis longus, the DBPIN divided into a lateral branch that innervated the abductor pollicis longus and extensor pollicis brevis, and a medial branch that innervated the extensor pollicis longus and extensor index proprius. The number of myelinated nerve fibers in the DAIN corresponded to 65% of that of the DBPIN. In each of the 5 patients, full thumb motion at the trapeziometacarpal joint was restored with no, or minimal, extension lag at the metacarpophalangeal (MCP) joint. CONCLUSIONS The anatomy of the DBPIN is predictable. Transferring the DAIN to the DBPIN is feasible through a single dorsal approach, allowing full recovery of thumb motion. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Jayme Augusto Bertelli
- Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Santa Catarina, Brazil; Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil.
| | - Sushil Nehete
- Wockhardt Hospital, The Umrao IMSR, Thane, Maharashtra, India
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Chaudhry S, Ipaktchi KR, Ignatiuk A. Updates on and Controversies Related to Management of Radial Nerve Injuries. J Am Acad Orthop Surg 2019; 27:e280-e284. [PMID: 30856632 DOI: 10.5435/jaaos-d-17-00325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Radial nerve injuries are among the most common major traumatic peripheral nerve injuries. Recent literature has updated our knowledge of aspects ranging from radial nerve anatomy to treatment options. Observation and tendon transfers were, and still are, the mainstays of management. However, the improved outcomes of nerve repair even 5 months after injury have changed the treatment algorithm. Nerve repair techniques using conduits, wraps, autograft, and allograft allow tension-free coaptations to improve success. Nerve transfers have evolved to allow a more anatomic recovery of function if used in a timely manner. This review offers an update on radial nerve injuries that reflects recent advances.
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Affiliation(s)
- Sonia Chaudhry
- From the Department of Orthopaedics, Connecticut Children's Medical Center, Hartford, CT (Dr. Chaudhry), the Department of Orthopaedics, University of Colorado, Denver, CO (Dr. Ipaktchi), and Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ (Dr. Ignatiuk)
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Şirinoğlu H, Certel F, Yeşïloğlu N, Temïz G, Kalafatlar KE, Sarici M, Çelebïler Ö. A Rare Type of Upper Extremity Injury: Penetrating Injuries Caused by Blunt-edged Items. J Hand Surg Asian Pac Vol 2017; 22:59-64. [PMID: 28205467 DOI: 10.1142/s0218810417500101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Penetrating upper extremity injury is a common encountered cause of significant loss of labor force and it is generally caused by sharp items. This article presents five rare cases of penetrating hand and forearm injury caused by blunt-edged items in conjunction with a detailed discussion of the mechanism and management of the injury. METHODS Five patients with a mean age of 37.6 were treated for upper extremity trauma caused by "blunt-edged items" such as corrugated iron fence, garden wires, iron stick or iron safety fence between 2009 to 2014. All patients were operated under general anesthesia after performing detailed physical examination and x-ray imaging. RESULTS The explorative surgery of the affected limbs revealed no nervous or vascular injury. In two patients, partial tear of the muscles bellies of intrinsic hand muscles (opponens pollicis and adductor pollicis); in two patients, partial extensor digitorum communis tendon laceration and in the remaining patient, partial tear of the third annular pulley were the only encountered injuries. The physical examinations performed in the last visit of each patient revealed, complete healing of the affected limb without any functional, vascular or sensorial deficiency in a mean follow-up period of 19.2 months. CONCLUSIONS Despite their initial horrible appearance, injuries caused by "blunt-edged items" are quite harmless to the affected limb because they follow weak anatomic spaces of the extremity and cause minimal tissue damage leaving all vascular and nervous structures intact.
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Affiliation(s)
- Hakan Şirinoğlu
- * Department of Plastic Reconstructive and Aesthetic Surgery, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Turkey
| | - Furkan Certel
- † Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Nebil Yeşïloğlu
- * Department of Plastic Reconstructive and Aesthetic Surgery, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Turkey
| | - Gökhan Temïz
- * Department of Plastic Reconstructive and Aesthetic Surgery, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Turkey
| | - Kübra Ece Kalafatlar
- * Department of Plastic Reconstructive and Aesthetic Surgery, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Turkey
| | - Murat Sarici
- * Department of Plastic Reconstructive and Aesthetic Surgery, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Turkey
| | - Özhan Çelebïler
- † Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University School of Medicine, Istanbul, Turkey
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