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Macêdo LP, Freire Filho JBM, de Souza FHM, Almeida NS, Azevedo-Filho HRC. Transfer of the phrenic nerve to musculocutaneous nerve via sural nerve graft after total brachial plexus injury. Br J Neurosurg 2024; 38:546-547. [PMID: 34180321 DOI: 10.1080/02688697.2021.1908518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
A middle age male presented a right total brachial plexus injury after motorcycle fall one year ago. Subsequent electromyographic evaluation was consistent with C5, C6, C7, C8 and T1 root avulsion. The patient was submitted to a right transfer of the phrenic nerve to musculocutaneous nerve , using rural nerve graft.
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Chung E. Recovery of iatrogenic erectile dysfunction with somatic-to-autonomic sural nerve graft. BJU Int 2024; 133:231-232. [PMID: 38081596 DOI: 10.1111/bju.16243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Affiliation(s)
- Eric Chung
- Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
- AndroUrology Centre, Brisbane, Queensland, Australia
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Shah HR, Bertelli JA. Long-Term Donor-Site Morbidity Following Entire Sural Nerve Harvest for Grafting. J Hand Surg Am 2023; 48:1173.e1-1173.e7. [PMID: 37923488 DOI: 10.1016/j.jhsa.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/31/2023] [Accepted: 03/10/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE The sural nerve is the autologous nerve used most commonly for grafting. However, recent studies indicate a high rate of complications and complaints after sural nerve removal. In this prospective study, we evaluated donor-site morbidity following full-length sural nerve harvesting on long-term follow-up. METHODS Fifty-one legs from 43 patients who underwent complete sural nerve harvesting for brachial plexus reconstruction were included in the study. After an average of 5 years, with a minimum postoperative follow-up of 12 months, sensory deficits in the leg and foot were analyzed using 2.0-g monofilaments. Regions of sensory deficit were marked with a skin marker and photographed. Over these regions of decreased sensation, we tested nociception using an eyebrow tweezer. Patients were also asked about pain, cold intolerance, pruritis, difficulties walking, and foot swelling. RESULTS Regions most affected (84% of patients) were over the calcaneus and cuboid. However, in these regions, nociception was preserved. Regions of decreased sensation extended to the calf region in 11 of 51 legs. In 13 patients, we also observed regions of decreased sensation on the proximal leg. In five feet, the sensation was entirely preserved. No patient had any complaints about pain, cold intolerance, itchiness, difficulties walking, or foot swelling. CONCLUSION Decreased sensation with nociception preserved was most common along the lateral side of the foot over the calcaneus and cuboid. Removing the entire sural nerve produced no long-term complaints of pain. Sural nerve use appears safe. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Harsh R Shah
- Department of Traumatology and Orthopedics, Clinical Hand Surgery Fellow, Governador Celso Ramos Hospital, Florianopolis, Santa Catarina, Brazil; Department of Plastic, Hand and Reconstructive Surgery, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Jayme A Bertelli
- Department of Traumatology and Orthopedics, Clinical Hand Surgery Fellow, Governador Celso Ramos Hospital, Florianopolis, Santa Catarina, Brazil; Department of Surgical Techniques, Federal University of Santa Catarina, Brazil.
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Kannan R, Khajuria A, Davies DC, Rymer B, Nduka C, Koshima I. Sural communicating nerve for application as a vascularized nerve graft: A microneurovascular anatomic study in cadavers. Microsurgery 2023; 43:818-822. [PMID: 37226423 DOI: 10.1002/micr.31068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/23/2023] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Sural nerve harvest causes paraesthesia to the lateral heel of the foot, which can debilitate those with already compromised proprioception. To circumvent this, we investigated an alternative donor nerve, branch of the lateral sural nerve complex called the sural communicating nerve (SCoNe), for its harvest and use as a vascularized nerve graft, in cadaver. METHODS The SCoNe was visualized by dissection in 15 legs from 8 human cadavers and the relationship of the SCoNe to the overall sural nerve complex was documented. The surface markings, dimensions, and the micro-neurovascular anatomy in the super-microsurgery range (up to 0.30 mm) of the SCoNe was recorded and analyzed. RESULTS SCoNe graft surface marking was confined within a triangle drawn between the fibular head laterally, the popliteal vertical midline medially and the tip of the lateral malleolus inferiorly. The proximal end of the SCoNe was situated at a mean intersection distance of 5 cm from both the fibular head and popliteal midline respectively. The mean length of the SCoNe was 226 ± 43 mm with a mean proximal diameter of 0.82 mm and mean distal diameter of 0.93 mm. In 53% of the cadavers, an arterial input was present in the proximal third of the SCoNe and veins were predominantly (87%) present in the distal third. In 46% and 20% of the 15 legs respectively, there was a nutrient artery and vein perfusing the SCoNe in its central segment. The external mean diameter of this artery was 0.60 ± 0.30 mm, while the vein was slightly larger with a mean diameter of 0.90 ± 0.50 mm. DISCUSSION SCoNe graft may preserve lateral heel sensation, compared to sural nerve harvest, pending clinical studies. It may have wide applications as a vascularized nerve graft, including being ideal as a vascularized cross-facial nerve graft because its nerve diameter is similar to the distal facial nerve branches. The accompanying artery is a good anastomotic match to the superior labial artery.
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Affiliation(s)
- Ruben Kannan
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Ankur Khajuria
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, UK
- Kellogg College, University of Oxford, Oxford, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - D Ceri Davies
- Human Anatomy Unit, Imperial College London, London, UK
| | - Ben Rymer
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Charles Nduka
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Isao Koshima
- Department of Plastic Surgery, Hiroshima University Hospital, Hiroshima, Japan
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Dangerfield DC, Coombs CJ. 'Case of the Month' from the University of Melbourne, Melbourne, Australia: treatment of iatrogenic erectile dysfunction with somatic-to-autonomic sural nerve grafting. BJU Int 2023; 132:262-265. [PMID: 37161891 DOI: 10.1111/bju.16034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
| | - Christopher J Coombs
- Department of Surgery, The University of Melbourne, Parkville, Vic., Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Vic., Australia
- Southern Plastic Surgery, Brighton, Vic., Australia
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Harb JL, Ein LJ. The Role of the Cross Face Nerve Graft in Facial Reanimation and Endoscopic Harvest of the Sural Nerve. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:25-31. [PMID: 36754504 DOI: 10.1016/j.cxom.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Cross-face nerve grafting (CFNG) allows for spontaneous, involuntary facial movement for patients with irreversible hemifacial paralysis. This technique uses an intact contralateral facial nucleus and nerve as an input and axon source, allowing donor neural input to be routed through a nerve graft across the face. The sural nerve is well equipped for use as a nerve graft due to its length and minimal donor site morbidity. Endoscopic nerve harvest techniques allow for efficient, minimally invasive dissection that improves the integrity of the harvested nerve.
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Affiliation(s)
- Jennifer L Harb
- Department of Otolaryngology - Head and Neck Surgery, University of Miami Miller School of Medicine, 1120 NW 14th Street, 5th Floor, Miami, FL 33136, USA
| | - Liliana J Ein
- Department of Otolaryngology - Head and Neck Surgery, University of Miami Miller School of Medicine, 1120 NW 14th Street, 5th Floor, Miami, FL 33136, USA.
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Thuau F, Lancien U, Crenn V, Perrot P, Duteille F. [The de-epidermized sural flap: An original technique to increase the reliability of the neurocutaneous sural flap]. ANN CHIR PLAST ESTH 2021; 67:93-100. [PMID: 34583875 DOI: 10.1016/j.anplas.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/03/2021] [Accepted: 08/30/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The neurocutaneous sural flap is useful to cover defects of the distal quarter of the lower limb. Nevertheless, severe complications occur in 14% of the cases, and venous congestion is reported in 75% of these cases. This congestion can lead to total necrosis of the flap and a failure of the procedure. We describe a new surgical method aiming to reduce the risk of venous congestion occurrence and failure of the defect coverage. PATIENTS AND METHODS We realized a retrospective study of patients who undergone a de-epidermized distally based neurocutaneous sural flap in our surgery department from 2015 to 2020. The following data were collected: sex, age, vascular risk factors, size of the wound, defect area, etiology, delay between the surgery of the flap and the split-thickness skin graft and complications. RESULTS The cohort is composed of 5 cases. We reported no failure of the coverage of the defect. There were no cases of venous congestion. CONCLUSION The de-epidermized distally based neurocutaneous sural flap could increase the reliability of these flaps by reducing the risk of venous congestion. A larger study comparing the classic technique to the de-epidermized sural flap could confirm these data on a greater number of cases and position this technique in the therapeutic arsenal.
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Affiliation(s)
- F Thuau
- Service de chirurgie plastique et reconstructrice, centre de traitement des brûlés adultes et enfants, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - U Lancien
- Service de chirurgie plastique et reconstructrice, centre de traitement des brûlés adultes et enfants, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - V Crenn
- Service de chirurgie orthopédique et traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; Laboratoire PhyOS Inserm UMR 1238, faculté de médecine, 1 rue Gaston-Veil, 44000 Nantes, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, centre de traitement des brûlés adultes et enfants, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - F Duteille
- Service de chirurgie plastique et reconstructrice, centre de traitement des brûlés adultes et enfants, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
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BÜYÜKMUMCU M, AYDIN KABAKÇI AD, AKIN SAYGIN D, YILMAZ MT, ŞEKER M. Sural nerve harvest for infants: integrated with information based on anatomical dissections. Turk J Med Sci 2021; 51:473-482. [PMID: 32718120 PMCID: PMC8203145 DOI: 10.3906/sag-2005-225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/21/2020] [Indexed: 11/03/2022] Open
Abstract
Background/aim The aim of the present study was to determine the course and possible variations of the sural nerve with all anatomical details in human fetal cadavers. Materials and methods This study was performed on 60 fetal cadavers. Formation type and level of the sural nerve was detected. Results According to trimesters, it was determined that the mean transverse and vertical distance between the lowest point of the LM and the SN varied between 1.1 and 2.9 mm and 1.54 and 3.58 mm, respectively. Type 2 was the most common seen type of sural nerve (35.83%). It was determined that the sural nerve was mostly formed at the middle third of the leg (42.5%). Conclusion Sural nerve graft with the knowledge of the anatomical details may be used for peripheral nerve reconstruction is required in congenital lesions, such as facial paralysis, obstetric brachial paralysis, and posttraumatic lesions in infants and children.
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Affiliation(s)
- Mustafa BÜYÜKMUMCU
- Department of Anatomy, Faculty of Meram Medicine, University of Necmettin Erbakan, KonyaTurkey
| | | | - Duygu AKIN SAYGIN
- Department of Anatomy, Faculty of Meram Medicine, University of Necmettin Erbakan, KonyaTurkey
| | - Mehmet Tuğrul YILMAZ
- Department of Anatomy, Faculty of Meram Medicine, University of Necmettin Erbakan, KonyaTurkey
| | - Muzaffer ŞEKER
- Department of Anatomy, Faculty of Meram Medicine, University of Necmettin Erbakan, KonyaTurkey
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MUKOHARA SHINTARO, INUI ATSUYUKI, MIFUNE YUTAKA, NISHIMOTO HANAKO, KATAOKA TAKESHI, KUROSAWA TAKASHI, YAMAURA KOHEI, KURODA RYOSUKE. Isolated Nerve Grafting for a Young Patient with a Complete Common Peroneal Nerve Palsy Following a Traumatic Knee Dislocation: A case report. Kobe J Med Sci 2020; 65:E110-E113. [PMID: 32029696 PMCID: PMC7012322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Common peroneal nerve (CPN) injury following a knee dislocation is a serious problem, and an optimal treatment is yet to be established. We report a case of complete CPN palsy following a knee dislocation treated with sural nerve grafting. CASE A 19-year-old man suffered a knee injury during a hurdle race. Diagnosis in a previous hospital revealed a complex ligament injury with CPN palsy. Ten weeks following injury, he was admitted to our institution because of a lack of neurological improvement. Considering the grade 0 results obtained in the manual muscle test (MMT) of tibialis anterior (TA) and extensor hallucis longus (EHL), the patient was diagnosed with complete neurotmesis of CPN, and surgery was performed. Operative findings revealed CPN discontinuity and an extended nerve defect length of 15 cm; therefore, sural nerve grafting was performed to repair the CPN injury. One year postoperatively, a grade 1 result from MMT of TA and EHL indicated a gradual neurological recovery. Three years postoperatively, MMT of TA and EHL showed significant improvement to grade 4+ and grade 4, respectively, and he could walk and jog without a knee brace. DISCUSSION Nerve graft length of >6 cm has shown limited success, and their efficacy for the treatment of CPN palsy following knee dislocations is controversial. However, young patients with complete CPN lesion are more likely to recover regardless of the length of nerve injury. Therefore, in such cases, nerve grafting can be considered as one of the treatments for complete CPN lesion following knee dislocations.
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Affiliation(s)
| | - ATSUYUKI INUI
- Phone: +81-78-382-5985, Fax: +81-78-351-6944, E-mail:
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Rosero-Britton B, Uribe A, Stoicea N, Periel L, Bergese SD. Negative pressure pulmonary edema postextubation following medial nerve repair with sural graft surgery in a young patient: A case report. Medicine (Baltimore) 2018; 97:e13743. [PMID: 30593150 PMCID: PMC6314689 DOI: 10.1097/md.0000000000013743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
RATIONALE Negative pressure pulmonary edema (NPPE) is a serious well-described pulmonary complication. It occurs after an intense inspiratory effort against an obstructed or closed upper airway and generates a large negative airway pressure, leading to severe pulmonary edema (transvascular fluid filtration and interstitial/alveolar edema) and hypoxemia. We present a case of NPPE following general anesthesia in a patient who underwent median nerve neurorrhaphy with graft from lower left limb (sural nerve) due to sharp injury. PATIENT CONCERNS A 39-year-old Hispanic male was admitted to the Hospital Universitario de San José and scheduled to undergo a median nerve neurorrhaphy under general anesthesia. Preoperative vital signs, physical examination, and laboratory assessments were unremarkable. At the end of surgery, anesthetic agents were ceased after patient responded to commands and maintained eye contact. However, immediately after extubation, anesthesia care providers observed marked respiratory distress and rapid development of hypoxia. DIAGNOSES After extubation, patient presented multiple episodes of hemoptysis, tachypnea (25 per minute), blood oxygen saturation (SpO2) of 82% and abundant bilateral pulmonary rales. A baseline chest x-ray revealed symmetric parenchymal opacities with ground-glass attenuation and bilateral multilobar consolidations patterns. The diagnosis of NPPE was established and supportive treatment was initiated. INTERVENTIONS The patient received noninvasive mechanical ventilation with a PEEP at 10 cmH2O, intravenous furosemide (20 mg.) every 12 hours, and fluids restriction. Patient remained in PACU for continuing monitoring and laboratory/imaging follow-up testing until next morning. OUTCOMES On postoperative day 1, patient responded satisfactorily to supportive treatment and transferred to the general care floor; oxygen supplementation was discontinued 12 hours after extubation time. On postoperative day 3, after the evaluation of a chest x-ray, patient was discharged to home in stable conditions LESSON:: The occurrence of NPPE in the perioperative setting could be successfully managed with supportive regimens, effective clinical team coordination, and awareness of the importance of its rapid diagnosis.
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Affiliation(s)
- Byron Rosero-Britton
- Grupo de Investigaciones Básicas y Clínicas, Gibacus, Universidad del Sinú, Cartagena
- Department of Anesthesiology, Hospital Universitario de San José, Bogota, Colombia
| | - Alberto Uribe
- The Ohio State University Wexner Medical Center, Department of Anesthesiology
| | - Nicoleta Stoicea
- The Ohio State University Wexner Medical Center, Department of Anesthesiology
| | - Luis Periel
- The Ohio State University Wexner Medical Center, Department of Anesthesiology
| | - Sergio D. Bergese
- The Ohio State University Wexner Medical Center, Department of Anesthesiology
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, OH
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Bertelli J, Soldado F, Ghizoni MF. Outcomes of Radial Nerve Grafting In Children After Distal Humerus Fracture. J Hand Surg Am 2018; 43:1140.e1-1140.e6. [PMID: 29903542 DOI: 10.1016/j.jhsa.2018.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/06/2018] [Accepted: 04/13/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the results of radial nerve grafting in 7 children who sustained a radial nerve injury following a distal humeral fracture. METHODS Seven children, mean age 6 years (range, 4-11 years), underwent nerve grafting for radial nerve injuries following distal humeral fractures. The mean interval between injury and surgery was 6.7 months (range, 6-9 months). In all cases, 3 sural nerve graft cables were used, of mean length 8.6 cm (range, 6-12 cm). Mean follow-up was 19.9 months (range, 12-24 months). Wrist, finger, and thumb extension range of motion and strength were evaluated at final follow-up, using the British Medical Research Council (BMRC) rating scale. RESULTS The radial nerve was entrapped within the fracture site in 2 patients, and in 5, it was completely interrupted without entrapment. All patients obtained full active wrist extension with grade M4 BMRC strength. For finger extension, all patients were graded as M4, obtaining full metacarpophalangeal finger and thumb extension, with the wrist in neutral in 3 patients and fully extended in 4. During the thumbs-up test, 4 patients achieved complete extension of all thumb joints, and 3 exhibited metacarpophalangeal extension lag, averaging 30°. CONCLUSIONS Nerve grafting of radial nerve injuries at the level of the distal humerus in children can yield excellent outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Jayme Bertelli
- Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarinal, Brazil; Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil
| | - Francisco Soldado
- Pediatric Hand Surgery and Microsurgery Unit, Hospital Sant Joan de Deu; Universitat de Barcelona, Barcelona, Spain; Vithas San José Hospital, Vitoria, Spain.
| | - Marcos F Ghizoni
- Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil
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Catapano J, Shafarenko M, Ho ES, Zuker RM, Borschel GH. Sensory and functional morbidity following sural nerve harvest in paediatric patients. J Plast Reconstr Aesthet Surg 2018; 71:1711-1716. [PMID: 30268744 DOI: 10.1016/j.bjps.2018.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/26/2018] [Accepted: 07/28/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The sural nerve is a common donor site for nerve reconstruction. The only study describing outcomes in paediatric patients was following bilateral sural nerve harvest before the age of 1 year. Bilateral nerve harvest at such a young age may limit patients' ability to perceive a sensory difference. The objective of this study was to understand the sensory and functional deficit after unilateral sural nerve harvest in paediatric patients. METHODS A prospective case series was performed in children (age 6-18 years) following unilateral sural nerve harvest. The contralateral foot was used as a control. Sensory Threshold Evaluation was performed by Weinstein Enhanced Sensory Test (WEST) - Foot, and a Functional Sensory and Pain Questionnaire was administered. Sural nerve harvest was performed by a minimally invasive technique using a nerve stripper. RESULTS Twenty-eight feet of 14 patients that underwent unilateral sural nerve harvest were assessed. As a group, the 14 feet with sural nerve harvest demonstrated significantly higher thresholds in the four areas tested (p <0.05), thus identifying objective sensory loss at each location. The location of sensory loss in each patient was variable, with heavier sensory thresholds detected in 69.6% of areas tested than those in the corresponding location in the contralateral foot. Greater sensory loss was detected at the proximal lateral foot than at the distal lateral foot. Responses to the questionnaire revealed that only one patient perceived a sensory loss that affected their function. CONCLUSIONS Unilateral sural nerve harvest in paediatric patients resulted in measurable sensory loss. Despite loss of innervation, only two patients reported intermittent dysaesthesia or cold sensitivity, and the majority of the patients reported no functional deficit.
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Affiliation(s)
- Joseph Catapano
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mark Shafarenko
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Emily S Ho
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada
| | - Ronald M Zuker
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gregory H Borschel
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Watts RL, Mandir AS, Bakay RA. Intrastriatal Cografts of Autologous Adrenal Medulla and Sural Nerve in MPTP-Induced Parkinsonian Macaques: Behavioral and Anatomical Assessment. Cell Transplant 2017; 4:27-38. [PMID: 7728330 DOI: 10.1177/096368979500400106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To examine the effects of autologous sural nerve and adrenal medullary tissue intrastriatal cografts upon voluntary motor performance in parkinsonism, a non-human primate 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) model was employed to quantitatively assess skilled hand movements. Motor performance was studied in normal, MPTP-induced parkinsonian, and then cografted states. Reaction and movement times were prolonged and variability increased in experimental and control animals in the parkinsonian state. Animals undergoing autologous cografts demonstrated improved motor performance whereas the control animal continued in a chronic, stable parkinsonian state. Intrastriatal cografts of autologous adrenal medullary tissue and sural nerve resulted in good to excellent chromaffin cell survival. The mechanism of the restoration of function in the cografted monkeys remains to be determined.
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Affiliation(s)
- R L Watts
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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Zgonis T, Cromack DT, Stapleton JJ. Utilizing a Crossover Reverse Sural Artery Flap for Soft Tissue Reconstruction of the Plantar Forefoot After a Severe Degloving Injury. INT J LOW EXTR WOUND 2016; 6:114-9. [PMID: 17558010 DOI: 10.1177/1534734606298166] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extensive soft tissue defects involving the weight-bearing areas of the plantar aspect of the foot often require coverage with flaps. The options often include free flaps, free muscle flaps with split-thickness skin grafting, or local flaps. When presented with high-energy-induced soft tissue injuries of the foot, choices become narrow, secondary to the associated zone of injury. Free flaps require a viable recipient vessel suitable for microvascular anastomosis. Split-thickness skin grafts applied to the plantar aspect of the foot are prone to persistent breakdown. Local flaps if available are useful for coverage of plantar soft tissue defects. However, when local flaps of the affected limb are compromised or extension is not sufficient for coverage, crossover leg and foot flaps become invaluable. The reported cases of crossover sural artery flaps are sparse. To the best of the authors' knowledge, the few reported cases of crossover leg and sural artery flaps were described to provide soft tissue coverage over the heel and leg. The authors report a case of a crossover reverse sural artery flap for soft tissue coverage to the plantar aspect of the forefoot after a high-energy-induced degloving injury.
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Affiliation(s)
- Thomas Zgonis
- Department of Orthopaedics, The University of Texas Health Science Center at San Antonio 78229, USA.
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Leonetti JP, Marzo SJ, Petruzzelli GJ, Herr B. Recurrent Pleomorphic Adenoma of the Parotid Gland. Otolaryngol Head Neck Surg 2016; 133:319-22. [PMID: 16143173 DOI: 10.1016/j.otohns.2005.04.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Accepted: 04/01/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES: To assess the long-term results in the management of 42 patients with recurrent pleomorphic adenoma of the parotid gland. STUDY DESIGN: A retrospective analysis of 42 patients who underwent parotidectomy for recurrent pleomorphic adenoma was performed to study presenting clinicoradiographic features, surgical technique, facial nerve management, and the long-term risk of recurrence. RESULTS: All 42 patients had multi-focal, nontender recurrent nodules following one to four prior surgical procedures and 6 patients underwent prior radiotherapy. Surgical procedures included subtotal parotidectomy in 12 patients, total parotidectomy in 18 patients, parotidectomy with facial nerve resection in 7 cases, and subtotal petrosectomy with facial nerve resection in 5 individuals. The 2 patients with malignant transformation died of disseminated lung and bone metastasis. Twenty-nine of the remaining 40 patients had no recurrent disease. Seven patients developed local parotid bed or cutaneous recurrent disease, 2 patients died of unrelated causes, and 2 patients were lost to follow-up. CONCLUSIONS: All 7 patients with recurrent disease underwent subtotal parotidectomy with “negative” surgical margins. Total parotidectomy or subtotal petrosectomy with facial nerve resection in selected cases may reduce the risk of multiple episodes of pleomorphic adenoma recurrence. Two of 42 patients were found to have carcinoma ex-pleomorphic adenoma, both of these patients underwent prior radiotherapy, and both died of metastatic disease.
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Affiliation(s)
- John P Leonetti
- Loyola Center for Cranial Base Surgery, Maywood, IL 60153, USA.
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16
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Senes FM, Catena N, Dapelo E, Senes J. Nerve Transfer for Elbow Extension in Obstetrical Brachial Plexus Palsy. Ann Acad Med Singap 2016; 45:221-224. [PMID: 27383724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Filippo M Senes
- Reconstructive and Hand Surgery Unit, Department of Head, Neck and Neurosciences, Instituto Giannina Gaslini-Genova, Italy
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Baltzer HL, Spinner RJ, Bishop AT, Shin AY. Axillary Nerve Reconstruction: Anterior-Posterior Exposure With Sural Nerve Cable Graft Pull-Through Technique. Tech Hand Up Extrem Surg 2015; 19:168-175. [PMID: 26524659 DOI: 10.1097/bth.0000000000000103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Deltoid paralysis after axillary nerve injury results in limitations in shoulder function and stability. In the setting of an isolated axillary nerve injury with no clinical or electromyographic evidence of recovery that is within 6 to 9 months postinjury, the authors' preferred technique to reinnervate the deltoid is to reconstruct the axillary nerve with sural nerve grafting. Intraoperative neuromuscular electrophysiology is critical to determine the continuity of the axillary nerve before proceeding with reconstruction. The majority of the time, both an anterior and posterior incision and dissection of the axillary nerve is required to adequately delineate the zone of injury. This also ensures that both proximally and distally, uninjured axillary nerve is present before graft inset and also facilitates the ability to perform a meticulous microsurgical inset of the nerve graft posteriorly. The nerve graft must be pulled through from posterior to anterior to span the zone of injury and reconstruct the axillary nerve. Careful infraclavicular brachial plexus dissection is necessary to prevent further injury to components of the brachial plexus in the setting of a scarred bed. Patients will require postoperative therapy to prevent limitations in shoulder range of motion secondary to postoperative stiffness. This paper presents a detailed surgical technique for axillary nerve reconstruction by an anterior-posterior approach with a pull-through technique of a sural nerve cable graft.
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Wang XC, Li XF, Fang BR, Lu Q, Yang LC, Sun Y, A MT, Gao Y, Tang L, He JY, Wang YY. [Repair of defects in lower extremities with peroneal perforator-based sural neurofasciocutaneous flaps]. Zhonghua Shao Shang Za Zhi 2013; 29:432-435. [PMID: 24360001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore the operative technique and clinical results of using peroneal perforator-based sural neurofasciocutaneous flaps to repair skin and soft tissue defects in lower extremities. METHODS From January 2009 to March 2012, 26 patients with skin and soft tissue defects at distal region of leg and foot were hospitalized. Among them, 9 patients suffered from tendon or bone exposure at the distal region of leg after injury due to traffic accident; 4 patients suffered from skin defects in the ankle as a result of electric injury; 8 patients suffered from chronic ulcer at the distal part of leg and foot; 5 patients suffered from plantar pressure ulcer. After debridement, soft tissue defect sizes ranged from 11 cm×5 cm to 18 cm×13 cm. According to the position and size of the defects, peroneal perforator-based sural neurofasciocutaneous flaps were designed and procured to repair the skin and soft tissue defects. The size of flaps ranged from 12 cm×6 cm to 20 cm×15 cm. Flap donor sites were closed by direct suture or skin grafting. RESULTS Twenty-five flaps survived completely. Only one flap suffered partial margin necrosis in the size of 2 cm×1 cm, which was healed after dressing change. Patients were followed up for 6 to 12 months. The appearance and sensation of flaps were satisfactory; no ulcer occurred; the movement of lower extremities was normal. CONCLUSIONS It is suitable to repair the skin and soft tissue defects at distal region of leg and foot with the peroneal perforator-based sural neurofasciocutaneous flap, as it possesses reliable blood supply, long and non-bulky pedicle, and sufficient available size. The operation is also easy to perform.
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Affiliation(s)
- Xian-cheng Wang
- Department of Burns and Plastic Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Xiao-fang Li
- Department of Burns and Plastic Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Bai-rong Fang
- Department of Burns and Plastic Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Qing Lu
- Department of Burns and Plastic Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Li-chang Yang
- Department of Burns and Plastic Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Yang Sun
- Department of Burns and Plastic Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Mi-te A
- Department of Burns and Plastic Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Yuan Gao
- Department of Burns and Plastic Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Liang Tang
- Department of Burns and Plastic Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Ji-yong He
- Department of Burns and Plastic Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Yu-yin Wang
- Department of Burns and Plastic Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China
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Lineaweaver W. Immediate nerve grafts to a median nerve injury in a 7-year-old boy: 5-year follow-up. J Miss State Med Assoc 2013; 54:252-254. [PMID: 24371902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Immediate nerve grafts to traumatic injuries can achieve functional results in selected cases. This report describes 5 cm nerve grafts placed in a median nerve injury ofa 7-year-old boy. Five years later, the patient has a functional motor and sensory outcome.
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Affiliation(s)
- Xiaojuan Weng
- Department of Plastic Surgery, First Affiliated Hospital, Anhui Medical University, Hefei , Anhui , PR China.
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21
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Li J, Hu H, Wang H, Cheng X. [The effective analysis of microsurgical repair of radial nerve deep branch injury]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2012; 26:1344-1347. [PMID: 23230670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate the effectiveness and surgical skills of microsurgical repair of radial nerve deep branch injury. METHODS Between March 2001 and February 2011, 49 cases of radial nerve deep branch injury were treated by microsurgical technique. There were 40 males and 9 females with an average age of 32 years (range, 19-58 years), including 13 cases of knife-cut injury, 9 cases of electric-saw injury, 7 cases of dagger-stab injury, 6 cases of glass-cut injury, 5 cases of iatrogenic injury, 4 cases of Monteggia fracture, 3 cases of nailgun injury, and 2 cases of crush injury of the forearm complicated by fracture of the proximal radius. The disease duration ranged from 3 hours to 3 years and 8 months (mean, 4.9 months). The sites of injury were at front of supinator tube in 15 cases, in the supinator tube in 23 cases, and at back of supinator tube in 11 cases. One-stage repair was performed by end-to-end suture in 21 cases, including 9 cases of epineurial neurorrhaphy and 12 cases of perineurial neurorrhaphy; two-stage repair was performed in 28 cases, including 26 cases of sural nerve graft and 2 cases of neurolysis. RESULTS Postoperative wounds primarily healed. All patients were followed up 21.5 months on average (range, 12-39 months). At last follow-up, in 21 cases of one-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 13 cases, and level 4 in 8 cases; in 28 cases of two-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 2 cases, level 4 in 21 cases, level 3 in 4 cases, and level 2 in 1 case; and significant difference was found (Z=-5.340, P=0.000). In 9 cases undergoing epineurial neurorrhaphy at one-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 3 cases, and level 4 in 6 cases; in 12 cases undergoing perineurial neurorrhaphy at one-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 10 cases, and level 4 in 2 cases; and significant difference was found (Z=-2.279, P=0.023). In 26 cases undergoing nerve graft at two-stage repair, the muscle strength of the extensor pollicis longus was level 5 in 2 cases, level 4 in 20 cases, level 3 in 3 cases, and level 2 in 1 case; in 2 cases undergoing neurolysis at two-stage repair, the muscle strength of the extensor pollicis longus was level 4 in 1 case and level 3 in 1 case; and no significant difference was found (Z=-1.117, P=0.264). According to the upper arm function assessment criterion issued by Hand Surgery Association of Chinese Medicine Association, the results were excellent in 18 cases, good in 3 cases in one-stage repair patients; excellent in 2 cases, good in 21 cases, fair in 4 cases, and poor in 1 case in two-stage repair patients; and there was significant difference (Z=-5.340, P=0.000). CONCLUSION Microsurgical one-stage repair of radial nerve deep branch injury can obtain better effectiveness than two-stage repair by nerve graft, and perineurial neurorrhaphy is significantly better than epineurial neurorrhaphy.
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Affiliation(s)
- Jinyong Li
- Department of Orthopaedics, the Second People's Hospital of Zhengzhou, Zhengzhou Henan, 450006, P.R.China.
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Uchio E, Hoang D, Alam S, McRae M, Kishinevsky A, Narayan D. A novel device for minimally invasive harvest of the sural nerve. Conn Med 2012; 76:27-31. [PMID: 22372176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The sural nerve is ideal for autologous nerve reconstruction. Traditional open harvest techniques result in a large prominent scar, delayed ambulation and poor patient satisfaction. Accordingly, we have designed a neurotome device to exclusively harvest the sural nerve as a safe and effective alternative to traditional techniques. Five patients underwent sural nerve harvest using our neurotome device. Scanning electron microscopy confirmed the preservation of histological nerve architecture when compared to nerves harvested by traditional open technique. Patients who underwent traditional open harvest of the sural nerve were asked to fill out a questionnaire to assess patient satisfaction. Ninety-three percent preferred a shorter scar, 20% complained of difficult ambulation, while 50% found troubling sensory deficits. Patients undergoing sural nerve harvest by our novel technique were satisfied with the cosmetic results and had less difficulty in ambulation. To optimize operative technique, cadaveric dissection of 15 limbs was done to further define the anatomic relationship of the sural nerve to the short saphenous vein. Minimally invasive harvest of sural nerve through our novel technique yields good cosmetic and functional results.
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Affiliation(s)
- Edward Uchio
- Tower Research Institute, Tower Urology, Los Angeles, California, USA
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23
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Socolovsky M, Di Masi G, Battaglia D. Use of long autologous nerve grafts in brachial plexus reconstruction: factors that affect the outcome. Acta Neurochir (Wien) 2011; 153:2231-40. [PMID: 21866328 DOI: 10.1007/s00701-011-1131-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 08/08/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND Using grafts directed to distal targets in brachial plexus reconstruction has the advantage over proximal targets of avoiding axonal dispersion. A long graft (more than 10 cm) is needed to reach most distal targets. The objective of this article is to identify factors associated with good versus poor outcomes in a clinical series of long grafts used for distal brachial plexus reconstruction. METHODS In 34 patients with a flail arm, 47 sural grafts >10 cm long were followed for ≥2 years postoperatively. Surgical technique included standard supraclavicular exposure of the proximal brachial plexus and its branches, the phrenic nerve and spinal accessory nerve. Distal target nerves were exposed via an incision starting at the axilla, following the gap between the biceps and triceps. Cases achieving a good result were statistically compared against those with a poor result as to the donor nerve/root, target nerve, patient age and weight, time from trauma to surgery, graft length and long-term rehabilitation quality. FINDINGS A good outcome was observed with 23 grafts (48.9%), but 66.7% of the 30 long grafts done within 6 months of trauma yielded a good result. Only 1 of 15 patients with the lowest quality rehabilitation score experienced a good result (6.6%) versus all 12 patients with the highest rating (p < 0.001). Trauma-to-surgery time was roughly half as long in those with a good result (4.7 vs. 9.0 months, p < 0.001). No other inter-group differences were observed. CONCLUSIONS The results of a series of distal brachial plexus target reinnervations with long grafts is presented and analyzed. According to them, time from trauma to surgery and an adequate postoperative rehabilitation are important predictors of outcome.
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Affiliation(s)
- Mariano Socolovsky
- Department of Neurosurgery, Hospital de Clínicas University of Buenos Aires School of Medicine, Argentina.
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24
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Aghayan HR, Arjmand B, Norouzi-Javidan A, Saberi H, Soleimani M, Tavakoli SAH, Khodadadi A, Tirgar N, Mohammadi-Jahani F. Clinical grade cultivation of human Schwann cell, by the using of human autologous serum instead of fetal bovine serum and without growth factors. Cell Tissue Bank 2011; 13:281-5. [PMID: 21484231 DOI: 10.1007/s10561-011-9250-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 03/09/2011] [Indexed: 11/26/2022]
Abstract
Clinical grade cultivation of human schwann cell by the utilization of human autologous serum instead of fetal bovine serum, and also avoiding any growth factors, can increase safety level of this procedure in cases of clinical cell transplantation. The aim of this study was demonstration of the feasibility of clinical grade schwann cell cultivation. In this experimental study after obtaining consent from close relatives we harvested 10 sural nerves from brain death donors and then cultured in 10 seperated culture media plus autologous serum. We also prepared autologous serum from donor's whole blood. Then cultured cells were evaluated by S100 antibody staining for both morphology and purity. Cell purity range was from 97% to 99% (mean=98.11 ± 0.782%). Mean of the cell count was 14,055.56 ± 2,480.479 per micro liter. There was not significant correlation between cell purity and either the culture period or the age of donors (P>0.05). The spearman correlation coefficient for the cell purity with the period or the age of donors was 0.21 and 0.09, respectively. We demonstrated the feasibility of clinical grade schwann cell cultivation by the using of human autologous serum instead of fetal bovine serum and also without the using of growth factors. We also recommended all cell preparation facilities to adhere to the GMP and other similar quality disciplines especially in the preparation of clinically-used cell products.
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Affiliation(s)
- Hamid-Reza Aghayan
- Endocrinology and Metabolism Research Center & Brain and Spinal Cord Injury Repair Research Center, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, 14114, Tehran, Iran.
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25
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Jaminet P, Kraus A, Manoli T, Werdin F, Schaller HE, Sinis N. Accidental median nerve injury during trapezium resection and ligament reconstruction for primary rhizarthrosis. Microsurgery 2010; 30:502-4. [PMID: 20878732 DOI: 10.1002/micr.20768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Patel KB, Bartholomew SV, Wong MS, Stevenson TR. Distally based sural lesser saphenous neuro-veno-adipo-fascial (NVAF) flap for reconstruction in the foot: lessons learned. Foot Ankle Surg 2010; 16:e79-83. [PMID: 20655007 DOI: 10.1016/j.fas.2010.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 04/27/2010] [Accepted: 05/04/2010] [Indexed: 02/04/2023]
Abstract
We report nine cases in which the neuro-veno-adipo-fascial (NVAF) flap was used to perform reconstruction of foot wounds over a 7-year period. Complications occurred in five (56%) patients. One patient suffered total loss of the flap and four experienced partial loss of the NVAF flap. Complications are to be expected with the use of the NVAF flap for foot wounds, but in most cases the flap is salvageable. The NVAF flap is an option in foot reconstruction when free tissue transfer is not available, contraindicated due to patient factors or when a prior free flap has failed.
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Affiliation(s)
- Kamlesh B Patel
- Division of Plastic Surgery, UC Davis Medical Center, 2221 Stockton Boulevard, Suite 2125, Sacramento, CA 95817, United States.
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27
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Beidas O, Rayan GM, Al-Harthy A. Digital sucking induced trophic ulcers caused by nerve deficit from amniotic constriction band. J Plast Reconstr Aesthet Surg 2010; 63:e631-4. [PMID: 20347623 DOI: 10.1016/j.bjps.2010.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 12/15/2009] [Accepted: 01/19/2010] [Indexed: 11/30/2022]
Abstract
Two infants presented with amniotic constriction bands (ACB) in the distal third of the forearm. After teeth eruption they developed recurrent skin ulcerations mainly in the distribution of the median nerve from digital sucking. Both patients underwent reconstruction with multiple Z-plasties, followed by neurolysis of the ulnar nerve and sural nerve grafting of the median nerve. This neurological complication presented late in ACB as ulcerative lesions and secondary infection from digital sucking on the insensate digits. Thorough physical examination of the extremities at an early stage in children with ACB is essential to exclude an occult neurological dysfunction. Exploration of peripheral nerves is warranted in cases of deep forearm ACB during their soft tissue reconstruction.
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Gosk J, Rutowski R, Wnukiewicz W, Wiącek R, Urban M, Rabczyński J. Comparison of the results of surgical treatment after direct neurorrhaphy and reconstruction with sural nerve grafts in perinatal brachial plexus lesions. Folia Neuropathol 2010; 48:270-275. [PMID: 21225509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
The neurotmesis of elements of the brachial plexus in perinatal lesions requires microsurgical reconstruction. In this study we present our own experiences in surgical treatment of postganglionic lesions in the fifth degree of injury in Sunderland's scale. The clinical material consisted of 14 children aged from 2.5 to 6 months treated surgically due to neurotmesis of the neural elements of the brachial plexus. In 8 cases direct neurorrhaphy and in 6 cases reconstruction with sural nerve grafts were performed. During the operations material from the proximal stumps of the brachial plexus trunks was collected for histopathological examination. The analysis of the material comprised: clinical type of injury, location of postganglionic lesion and type of surgical procedure. The results of surgical treatment were evaluated using generally accepted scales (Gilbert's, Raimondi's, Al-Qattan's and British Medical Research Council scales). Comparison of the results of treatment between the surgical methods was also performed. Better results of surgical treatment were observed after direct neurorrhaphy. In our opinion the indications for these two methods are different and both operative techniques are useful in surgical treatment of perinatal brachial plexus palsy.
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Affiliation(s)
- Jerzy Gosk
- Department of Traumatology, Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Borowska 213, Wroclaw, Poland.
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Abstract
Nineteen patients with longstanding and permanent brachial plexus injuries underwent a three-staged surgical reconstruction. First, a sural nerve was grafted from the contralateral intact medial pectoral nerve to the paralyzed arm. One year later, a free gracilis muscle was transferred and neurotized by the grafted sural nerve. This procedure results in reanimation of elbow flexion. Finally, the biceps tendon was transferred to the finger flexors using a fascia bundle of tensor fascia lata muscle. Two of the gracilis muscle free transfers failed. In the remaining 17 patients, the overall result was evaluated as satisfactory in 11 patients and good in 6.
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Affiliation(s)
- J Gousheh
- Department of Plastic and Reconstructive Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Thomsen NOB, Dahlin LB. Injury to the radial nerve caused by fracture of the humeral shaft:Timing and neurobiological aspects related to treatment and diagnosis. ACTA ACUST UNITED AC 2009; 41:153-7. [PMID: 17701727 DOI: 10.1080/02844310701445586] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The radial nerve may not function in association with fractures of the humeral shaft. There are various opinions about the causes and treatment. We report a case of complete rupture of the radial nerve after a fracture of the proximal shaft of the humerus. The nerve injury was treated with grafting and TENDON transfer. Here we discuss diagnoses and treatments including neurobiological aspects of nervous regeneration. We suggest that electrodiagnostic examination after a radial nerve palsy caused by a humeral fracture is done 5-6 weeks after injury and that nerve repair and reconstruction should be done within two, and not later than three, months after injury.
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Affiliation(s)
- Niels O B Thomsen
- Department of Hand Surgery, Malmö University Hospital, Malmö, Sweden.
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Mathiesen T, Svensson M, Lundgren J, Kihlström L, Parisotto R, Bagger-Sjöbäck D. Hypoglossal schwannoma-successful reinnervation and functional recovery of the tongue following tumour removal and nerve grafting. Acta Neurochir (Wien) 2009; 151:837-41; discussion 841. [PMID: 19290472 DOI: 10.1007/s00701-009-0226-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 10/13/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Hypoglossal nerve schwannomas are rare tumours that usually cause ipsilateral hypoglossal palsy. This report describes such lesions in two patients and suggests nerve grafting as part of the treatment regimen. METHOD Two patients with intra- and extra-dural hypoglossal schwannomas respectively were treated by direct surgery via a postero-lateral approach to the posterior fossa, hypoglossal canal and carotid sheath. Following tumour removal, sural nerve grafting was used to reconstruct the nerves. Unexpectedly, muscle bulk and motor function returned within 6 months in both patients. CONCLUSION Nerve grafting was highly successful in achieving functional recovery following surgery for hypoglossal nerve schwannomas.
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Affiliation(s)
- Tiit Mathiesen
- Department of Neurosurgery, Skull Base Center, Karolinska Hospital, Stockholm, Sweden
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Davis JW, Chang DW, Chevray P, Wang R, Shen Y, Wen S, Pettaway CA, Pisters LL, Swanson DA, Madsen LT, Huber N, Troncoso P, Babaian RJ, Wood CG. Randomized phase II trial evaluation of erectile function after attempted unilateral cavernous nerve-sparing retropubic radical prostatectomy with versus without unilateral sural nerve grafting for clinically localized prostate cancer. Eur Urol 2009; 55:1135-43. [PMID: 18783876 PMCID: PMC10651170 DOI: 10.1016/j.eururo.2008.08.051] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 08/21/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nonrandomized studies of unilateral nerve-sparing (UNS) radical prostatectomy (RP) have reported improved recovery of erectile function if the sacrificed cavernous nerve is reconstructed with a sural nerve graft (SNG). OBJECTIVE To determine whether UNS RP plus SNG results in a 50% relative increase in potency at 2 yr compared to UNS RP alone. DESIGN, SETTING, AND PARTICIPANTS The study enrolled patients from October 2001-May 2006 from a single academic center and was randomized, open label. Participants were men with localized prostate cancer recommended for UNS RP, less than 66 yr old, normal baseline erectile function, and willing to participate in early erectile dysfunction (ED) therapy. Patients were followed up to 2 yr. INTERVENTION Patients underwent UNS RP and ED therapy starting at 6 wk: oral prostaglandin type-5 (PDE5) inhibitor, vacuum erection device (VED), and intracavernosal injection therapy. In the SNG group, a plastic surgeon performed the procedure at the time of RP. MEASUREMENTS The ability to have an erection suitable for intercourse with or without a PDE5 inhibitor at 2 yr. The hypothesis was that SNG would result in a 60% potency rate compared to 40% for controls (80% power, 5% two-way significance). RESULTS AND LIMITATIONS The trial planned to enroll 200 patients, but an interim analysis at 107 patients met criteria for futility and the trial was closed. For patients completing the protocol to 2 yr, potency was recovered in 32 of 45 (71%) of SNG and 14 of 21 (67%) of controls (p=0.777). By intent-to-treat analysis, potency recovered in 32 of 66 (48.5%) of SNG and 14 of 41 (34%) of controls (p=0.271). No differences were seen in time to potency or quality of life scores for ED and urinary function. Limitations included slower-than-expected accrual and poor compliance with ED therapy: <65% for VED and <40% for injections. CONCLUSIONS The addition of SNG to a UNS RP did not improve potency at 2 yr following surgery. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT00080808, http://www.clinicaltrials.gov/ct2/show/NCT00080808?term=NCT00080808&rank=1.
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Affiliation(s)
- John W Davis
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Tederko P, Krasuski M, Kiwerski J, Nyka I, Białoszewski D. Repair therapies in spinal cord injuries. Ortop Traumatol Rehabil 2009; 11:199-208. [PMID: 19620739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Spinal cord repair therapies (SCRT) are experimental treatments which are attracting a growing interest among both spinal cord injury sufferers and their families as well as physicians and physiotherapists. Basing on current professional literature, this article presents the most important SCRT strategies. The majority of currently developed SCRTs are at the stage of experimental in vitro or animal studies. Few of these studies are in the early clinical trial stage or are being offered as non-standard commercial health care services. Basing on a review of the literature, it can be stated that currently there are few studies which meet the criterion of reliability, and their results make possible an objective assessment of the safety and efficacy of SCRT. Available study results are insufficient to confirm the advisability of widespread application of these methods.
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Affiliation(s)
- Piotr Tederko
- Rehabilitation Department, Medical University of Warsaw, Warsaw, Poland.
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Gontero P. Editorial comment on: Randomized phase II trial evaluation of erectile function after attempted unilateral cavernous nerve-sparing retropubic radical prostatectomy with versus without unilateral sural nerve grafting for clinically localized prostate cancer. Eur Urol 2008; 55:1144. [PMID: 18783874 DOI: 10.1016/j.eururo.2008.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Erba P, Wettstein R, Tolnay M, Rieger UM, Pierer G, Kalbermatten DF. Neurocutaneous sural flap in paraplegic patients. J Plast Reconstr Aesthet Surg 2008; 62:1094-8. [PMID: 18562264 DOI: 10.1016/j.bjps.2008.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 02/04/2008] [Accepted: 02/08/2008] [Indexed: 11/18/2022]
Abstract
Neurocutaneous flaps have been demonstrated to be a reliable option in different groups of patients but it remains unclear if distally-based sural flaps can be safely used in paraplegic patients because they suffer from significant nervous system alterations. The aim of this proof-of-concept study is to demonstrate that these flaps are reliable in paraplegic patients. We prospectively analysed a group (n=6) of paraplegic patients who underwent reversed sural flap surgery for ulcers on the lateral malleolus. Measurement of area and photographic documentation techniques have been employed to quantify the defect area. Sural nerve biopsies have been analysed histologically with several different staining techniques to assess the neurovascular network and the myelinisation of the nerve. The patients showed uneventful wound healing, except one case that suffered a partial flap necrosis that healed by secondary intention. Histologic analysis revealed an intact neurovascular network and myelinated nerve fibres. In this small series of paraplegic patients that underwent a distally-based sural flap, the complication rate was low, with only one case of superficial partial necrosis demonstrating the reliability and safety of the flap in this subset of patients. Histologic evaluation of sural nerve biopsies revealed an almost normal morphology. A possible explanation of this phenomenon is that the dorsal root ganglia remain intact in paraplegic patients and can preserve neural characteristics in the peripheral sensory nerve system.
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Affiliation(s)
- P Erba
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, CH-4031 Basel, Switzerland
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Leonetti JP, Zender CA, Vandevender D, Marzo SJ. Long-term results of microvascular free-tissue transfer reanimation of the paralyzed face: three cases. Ear Nose Throat J 2008; 87:226-233. [PMID: 18478799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
We conducted a retrospective case review at our tertiary care academic medical center to assess the long-term results of microvascular free-tissue transfer to achieve facial reanimation in 3 patients. These patients had undergone wide-field parotidectomy with facial nerve resection. Upper facial reanimation was accomplished with a proximal facial nerve-sural nerve graft, and lower facial movement was achieved through proximal facial nerve-long thoracic (serratus muscle) nerve anastomosis. Outcomes were determined by grading postoperative facial nerve function according to the House-Brackmann system. All 3 patients were able to close their eyes independent of lower facial movement, and all 3 had achieved House-Brackmann grade III function. We conclude that reanimating the paralyzed face with microvascular free-tissue transfer provides anatomic coverage and mimetic function after wide-field parotidectomy. Synkinesis is reduced by separating upper- and lower-division reanimation.
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Affiliation(s)
- John P Leonetti
- Department of Otolaryngology-Head and Neck Surgery, Loyola Center for Cranial Base Surgery, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA.
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Talbot M. Surgical images: musculoskeletal: Sural neurocutaneous cross-leg flap. Can J Surg 2008; 51:150. [PMID: 18377757 PMCID: PMC2386333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- Max Talbot
- Orthopaedic Trauma, 1 Canadian Field Hospital, Canadian Forces, Canada
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Hanson GR, Borden LS, Backous DD, Bayles SW, Corman JM. Erectile function following unilateral cavernosal nerve replacement. Can J Urol 2008; 15:3990-3993. [PMID: 18405447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION With nerve-sparing techniques, patients undergoing a radical prostatectomy may avoid the morbidity of erectile dysfunction. Certain patients who are not candidates for nerve-sparing procedures may be eligible for nerve interposition grafts. While bilateral cavernosal nerve grafting after radical prostatectomy has shown efficacy, the effect of unilateral nerve grafting following prostatectomy remains unclear. We evaluate a large group of patients who underwent a unilateral cavernosal nerve replacement. METHODS Forty patients underwent unilateral nerve sparing surgery with concomitant contralateral cavernosal nerve replacement. Patients were selected for this procedure based upon preoperative nomogram risk assessment, endorectal MRI evidence of extra capsular disease (ECE) or intraoperative histology demonstrating margin positivity. Age, demographic data, Gleason score, clinical and pathologic stage and pre and post operative IIEF data was collected and prospectively analyzed. RESULTS Median follow-up was 19 months. Median change in IIEF scores was 7.5. Twenty-one of 29 patients (72%) report being able to penetrate after prostatectomy. Sixteen of those 21 (76%) continue to require PDE-5 inhibitors to facilitate penetration. Four of the 6 patients (67%) who were unable to have intercourse following cavernosal nerve replacement received adjuvant hormonal and/or radiation therapy. Twenty-eight patients (97%) reported numbness at the graft harvest site. One patient experienced a graft site infection. Two of 29 (7%) patients reported pain at the harvest site. CONCLUSION Unilateral sural nerve grafting is a feasible and well-tolerated approach for patients who must undergo wide resection of a NVB. While men do show a decrease in their IIEF score, 76% are able to achieve penetration following surgery. The majority of men continue to require PDE-5 inhibitors to facilitate intercourse.
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Affiliation(s)
- Gregory R Hanson
- Section of Urology, Virginia Mason Medical Center, Seattle, Washington, USA
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Dong ZG, Liu LH, Zheng L. [Reconstruction of foot and ankle defect with reversed sural neurofasciocutaneous flaps in children]. Zhonghua Zheng Xing Wai Ke Za Zhi 2008; 24:20-22. [PMID: 18437976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To investigate the clinical application of reversed sural neurofasciocutaneous flaps in children. METHODS From January 2002 to January 2007, 16 children patients with deep defect of foot and ankle were treated with reversed sural neurofasciocutaneous flaps. The size of the flaps ranged from 6.5 cm x 5.0 cm to 17 cm x 10 cm. The upper margin of the flaps reached the upper one-third of the leg in 10 cases, with 2 cases reaching the popliteal fossa and 1 case reaching 1.5 cm above the transverse line of popliteal fossa. RESULTS The flaps survived completely in 14 cases. There were partial necrosis at the distal end of flap in one case and superficial necrosis at the distal end of the flap in one case. The wounds were healed spontaneously after secondary suture and dressing change. The patients were followed up for 2 - 46 months with good aesthetic results. CONCLUSIONS The reverse sural neurofasciocutaneous flaps in children has a reliable survival area, which can reach the upper on -third of the leg until the transverse line of popliteal fossa. It is an ideal reconstructive method for deep defect of foot and ankle.
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Affiliation(s)
- Zhong-Gen Dong
- Department of Orthopedics, 2nd Xiangya Hospital, Central SouthUniversity, Changsha 410011, China
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Shahzadi S, Abouzari M, Rashidi A. Bilateral traumatic hypoglossal nerve transection in a blast injury. Surg Neurol 2007; 68:464-5. [PMID: 17905077 DOI: 10.1016/j.surneu.2006.10.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 10/24/2006] [Indexed: 05/17/2023]
Abstract
BACKGROUND The hypoglossal nerve supplies motor function to the tongue. CASE DESCRIPTION A 21-year-old man was injured in a blast injury to his mandible, resulting in severe maxillofacial hemorrhaging. Irreversible injury was evident from lack of improvement to tongue; patient underwent transplantation by end-to-end coaptation of right injured nerve 6 months after injury, with subsequent repair to left nerve 2 months later. At 11-year follow up, there was acceptable force and normal motor activity. Only speech, mastication, and swallowing did not return to normal despite prolonged physiotherapy. CONCLUSION In hypoglossal nerve injury, the proximity of the injury site to the primary muscle and, therefore, the short time required for the nerve fibers to repair toward the muscle are expected to predict an excellent outcome after transplantation. However, this is not usually the case, as in our patient.
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Affiliation(s)
- Sohrab Shahzadi
- Shohada General Hospital, Shaheed Beheshti University of Medical Sciences, Tehran 1574-5679, Iran
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Reyes O, Sosa IJ, Santiago J, Kuffler DP. A novel technique leading to complete sensory and motor recovery across a long peripheral nerve gap. P R Health Sci J 2007; 26:225-228. [PMID: 18035815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Sensory nerve grafts are the "gold standard" for inducing neurological recovery in peripheral nerves with a gap. However, the effectiveness of sensory nerve grafts is variable, generally not leading to complete sensory and motor recovery, with good recovery limited to gaps shorter than 2 cm, and the extent of recovery decreasing with increasing graft length. An alternative technique using a conduit filled with pure fibrin to bridge a nerve gap leads to only limited neurological recovery. We tested the effectiveness of a novel nerve repair technique in which a 5-cm long radial nerve gap was repaired using two sural nerve graft surrounded by a collage tube filled with pure fibrin. By 1 1/2 years post surgery, the patient recovered complete sensory and motor function. In conclusion, this study suggests that the combination of pure fibrin surrounding sural nerve grafts is responsible for inducing the extensive neurological recovery induced by either pure fibrin or sural grafts alone. This technique is presently being tested in a clinical trial.
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Teh BS, Bastasch MD, Mai WY, Kadmon D, Miles BJ, Butler EB. Preliminary Report of the Effect of High-Dose Adjuvant Intensity Modulated Radiation Therapy on the Sural Nerve Graft for Cavernosal Nerve Sacrifice After Radical Prostatectomy. Am J Clin Oncol 2007; 30:395-400. [PMID: 17762440 DOI: 10.1097/coc.0b013e318033728f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE A sural nerve graft may replace a killed cavernosal nerve. The effect of intensity-modulated radiation therapy (IMRT) on function of the graft has not been reported. MATERIALS AND METHODS Between 1998 and 2001, 8 patients (9 nerve grafts) were treated with postoperative IMRT (mean dose, 70 Gy). Two patients had neoadjuvant Lupron 30 mg 2 months prior to radiation. Potency was defined as ability to achieve spontaneous erection sufficient for vaginal penetration. Median follow-up was 31.6 months. RESULTS Five patients (62.5%) who had erectile function after prostatectomy preserved spontaneous erectile function after radiation. Of these, 3 patients had both nerves resected (two receiving unilateral grafts and one receiving bilateral grafts) and 2 others had one graft and one nerve preserved. The impotent patients were impotent after surgery. CONCLUSION High-dose postprostatectomy IMRT does not place sural nerve grafts at greater risk for failure. Larger numbers of patients are needed to confirm these encouraging, preliminary findings.
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Affiliation(s)
- Bin S Teh
- Department of Radiology/Section of Radiation Oncology, Methodist Hospital and Baylor College of Medicine, Houston, TX 77030, USA.
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Kuwata Y, Muneuchi G, Igawa HH, Tsukuda F, Inui M, Kakehi Y. Dissociation of sexual function and sexual bother following autologous sural nerve grafting during radical prostatectomy. Int J Urol 2007; 14:510-4. [PMID: 17593095 DOI: 10.1111/j.1442-2042.2006.01695.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM We prospectively investigated health-related quality of life (HR-QOL), including sexual function and sexual bother, in patients who underwent nerve grafting during a radical prostatectomy in comparison with those who underwent a non-nerve-sparing radical prostatectomy. METHODS Between August 2001 and May 2004, radical prostatectomies were performed on 69 patients with clinical T1-T2N0/M0 prostate cancer. Of these, 66 patients (22: nerve-grafting patients, 44: non-nerve-sparing and non-nerve-grafting patients) were enroled into this study. The observation periods ranged from 12-46 months (median: 29 months). The general HR-QOL was measured with the SF-36 General Health Survey and disease-specific HR-QOL was measured with the University of California Los Angeles-Prostate Cancer Index. RESULTS Penile tumescence was observed in 11 out of 15 (73.3%) prostate-specific antigen failure-free patients who underwent unilateral nerve grafting with contra-lateral nerve-sparing or bilateral nerve grafting. Vaginal penetration was observed in six out of 15 (40.0%) patients. The time for partial erection and for intercourse, respectively, ranged from 3-21 months (median = 6 months) and 6-36 months (median = 13.5 months). There were no significant differences in general HR-QOL changes over time between the nerve-grafting patients and the patients without any nerve-preserving procedures. The sexual function score was significantly better in the nerve-grafting (bilateral nerve graft or unilateral nerve graft with contra-lateral nerve-sparing) patients than in the non-nerve-sparing/non-nerve-grafting patients. The sexual bother score, however, was more serious for the patients who underwent nerve-grafting surgery than for the non-nerve-sparing/non-nerve-grafting patients. CONCLUSION Sexual bother is serious for patients who attempt to maintain sexual function after special surgical procedures, such as nerve-grafting surgery. We should be aware that careful counseling is needed to avoid impatient and excessive hope for the recovery of sexual function.
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Affiliation(s)
- Yoshihiro Kuwata
- Department of Urology, Kagawa University, Faculty of Medicine, Kagawa, Japan.
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Fujioka M, Tasaki I, Kitamura R, Yakabe A, Hayashi M, Matsuya F, Miyaguchi T, Tsuruta J. Cavernous nerve graft reconstruction using an autologous nerve guide to restore potency. BJU Int 2007; 100:1107-9. [PMID: 17578520 DOI: 10.1111/j.1464-410x.2007.07068.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present our experience of cavernous nerve graft reconstruction, using an autologous nerve vein-guide technique, to restore potency. PATIENTS AND METHODS Prostate cancers frequently require radical resection involving one or both cavernous nerves that usually results in erectile dysfunction; nerve grafting has been used to restore erectile function, but clinical results are unsatisfactory owing to inadequate surgical techniques. In all, eight patients with prostate cancer who required radical resection involving one cavernous nerve had sural nerve grafting, with two or three sutures using the autologous vein-guide technique, in our unit between 2004 and 2005. Because of the difficulty of performing microsurgical manoeuvres deep within the pelvic cavity, the nerve anastomosis might be unsatisfactory. RESULTS Seven of the eight patients had spontaneous erectile activity after grafting and six of these patients were able to have intercourse. CONCLUSION Sural nerve grafting using the autologous vein-guide technique is simple, has minimal morbidity, and yields good outcomes.
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Affiliation(s)
- Masaki Fujioka
- Department of Plastic and Reconstructive Surgery, National Nagasaki Medical Center, Nagasaki, Japan.
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Hyodo I, Ozawa T, Hasegawa Y, Ogawa T, Terada A, Torii S. Management of a Total Parotidectomy Defect With a Gastrocnemius Muscle Transfer and Vascularized Sural Nerve Grafting. Ann Plast Surg 2007; 58:677-82. [PMID: 17522494 DOI: 10.1097/01.sap.0000239844.57064.ed] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immediate facial nerve reconstruction is very demanding after total parotidectomy. Under such conditions, we reconstructed facial nerves using vascularized sural nerve with free lateral gastrocnemius muscle flap. The patient was a 14-year-old male diagnosed with mucoepidermoid carcinoma of the right parotid gland. We reconstructed zygomatic, buccal, and mandibular branches of facial nerve using 2 vascularized sural nerves, medial sural cutaneous nerve, and the lateral sural cutaneous nerve. The postoperative course was good, and there was no flap trouble. The reinnervated nerve recovered from 3 months after the operation. In 6 months after operation, almost normal animation was recovered, except for the corners of the patient's mouth. The advantages of this flap are feasible harvesting in the supine position, feasible filling of the dead space, possible harvesting of 2 series of lateral sural cutaneous nerve and median sural cutaneous nerve, and less sacrifice of the donor site. The disadvantage of this method is that the diameter of the pedicle is smaller than that of the medial pedicle. But the diameters of the lateral sural artery and vein are suitable to anastomose the cervical artery and vein. This flap is one of the good options for reconstruction of facial nerves after total parotidectomy.
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Affiliation(s)
- Ikuo Hyodo
- Department of Head and Neck Surgery and Reconstructive Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
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Namiki S, Saito S, Nakagawa H, Sanada T, Yamada A, Arai Y. Impact of unilateral sural nerve graft on recovery of potency and continence following radical prostatectomy: 3-year longitudinal study. J Urol 2007; 178:212-6; discussion 216. [PMID: 17499797 DOI: 10.1016/j.juro.2007.03.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Indexed: 11/27/2022]
Abstract
PURPOSE We conducted a 3-year longitudinal study assessing the impact of unilateral sural nerve graft on recovery of potency and continence following radical prostatectomy. MATERIALS AND METHODS A total of 113 patients undergoing radical retropubic prostatectomy were classified into 3 groups according to the degree of nerve sparing, that is unilateral nerve preservation with contralateral sural nerve graft interposition, bilateral nerve sparing and unilateral nerve sparing. Urinary continence and potency were estimated by the UCLA Prostate Cancer Index questionnaire. RESULTS Patients in the nerve sparing plus sural nerve graft group were younger than those in the bilateral nerve sparing or unilateral nerve sparing groups. At baseline the unilateral nerve sparing plus sural nerve graft group and the bilateral nerve sparing group reported better sexual function than the unilateral nerve sparing group (62.1 and 61.5 vs 49.9, p<0.05). The bilateral nerve sparing group showed more rapid recovery than the unilateral nerve sparing plus sural nerve graft group after radical retropubic prostatectomy (p<0.01). After 24 months there were no significant differences observed between the bilateral nerve sparing and the unilateral nerve sparing plus sural nerve graft group (28.7 vs 32.9). The bilateral nerve sparing group reported a better sexual function score than the unilateral nerve sparing group throughout the postoperative period (p<0.05). The bilateral nerve sparing group maintained significantly better urinary function at 1 month after radical retropubic prostatectomy than the unilateral nerve sparing plus sural nerve graft group (p <0.05). After 3 months these groups were almost continent. The unilateral nerve sparing group reported lower urinary function scores during the first year compared to the other groups. CONCLUSIONS The nerve graft procedure may contribute to the recovery of urinary function as well as sexual function after radical retropubic prostatectomy. This finding needs to be validated in a randomized trial.
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Affiliation(s)
- Shunichi Namiki
- Department of Urology, Tohoku University Graduate School of Medicine, Tohoku, Japan.
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Abstract
BACKGROUND The sural nerve is a sensory nerve that innervates the proximal part of the lateral aspect of the foot. The sural nerve is often harvested for nerve grafting. Sensory loss in the area supplied by the sural nerve could be expected, causing a lack of protective sensation and a potential risk of injury. The sensory outcome of sural nerve harvesting has not been documented in children. The aim of this study was to evaluate the sensory deficit following sural nerve harvest in infants. METHODS The authors conducted a controlled study. Evaluation and mapping of the sensory thresholds in the sural nerve distribution were performed using the Semmes-Weinstein monofilament method on four predetermined sites on the foot. A questionnaire was used to elicit subjective findings. The inclusion criteria were children older than 6 years who had undergone bilateral sural nerve harvesting for brachial plexus reconstruction in the first year of life. Normal volunteers served as controls. RESULTS Fourteen patients and 14 controls were enrolled in the study. Eighty-six percent of the feet that were operated on had a sensory deficit (p = 0.0001). The patients reported no concerns regarding the sensation of their feet. CONCLUSIONS Sural nerve harvesting in children leaves a measurable sensory deficit; however, this deficit does not seem to have clinical implications for the patients.
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Affiliation(s)
- Oren Lapid
- Division of Plastic Surgery and Clinical Research Support Unit, Population Health Sciences Program, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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Lin CH, Mardini S, Levin SL, Lin YT, Yeh JT. Endoscopically assisted sural nerve harvest for upper extremity posttraumatic nerve defects: an evaluation of functional outcomes. Plast Reconstr Surg 2007; 119:616-26. [PMID: 17230098 DOI: 10.1097/01.prs.0000253220.60630.99] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peripheral nerve injuries in the upper extremity often require interposition of sural nerve grafts for reconstruction. Due to the poor donor-site appearance with standard techniques, and the potential for trauma to the nerve because of poor visualization during the harvest when the stepladder technique is used, the endoscope has been employed for nerve harvest. METHODS From January of 1997 until December of 2003, 15 patients with an average age of 27.5 years with posttraumatic upper limb nerve defects of the ulnar, median, or posterior interosseous nerves (crush, cutting, or avulsion injuries) underwent reconstruction with endoscopically harvested sural nerve. The nerves were harvested using atraumatic techniques under video monitor visualization. The functional results of sensation and motor function were assessed using British Medical Research Council scales. RESULTS All patients regained at least cutaneous pain and tactile sensibility, with most regaining two-point discrimination (nine patients achieved S3+). Two patients achieved complete recovery (S4). The 11 patients with motor nerve involvement achieved between M1+ and M5 after the initial reconstruction. Eight patients required a total of one immediate and nine secondary procedures to achieve the final outcome. The procedures included tenolysis (three patients), intrinsic tendon transfers (four patients), and opponensplasty (three patients). At the 4-year mean follow-up, grip power was M5 in 13 patients (86.7 percent) and M4 in two patients (13.3 percent). CONCLUSIONS Upper extremity sensory and motor nerve defects can be reconstructed with interposition of endoscopically harvested sural nerve grafts. The procedure is reliable, quick, and atraumatic, and results in reasonable motor and sensory recovery.
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Affiliation(s)
- Chih-Hung Lin
- Division of Trauma, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
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Abstract
Reconstructive strategies for avulsion injuries of the brachial plexus have evolved from the irreparable and hopeless limb to the reparable and functional limb as a result of development of neurotization and free muscle transplantation. With more detailed knowledge of macro- and micro-nerve anatomy, the surgeon can be more confident in refining neurotization without causing a deficit in the donor nerve. Microsurgical anastomoses and nerve coaptation continue to be challenges in free muscle transplantation. End-to-side anastomoses or vein grafts are often required to facilitate access to the donor nerve for direct nerve coaptation. For functioning free muscle transplantation, every effort should be made to achieve direct nerve repair rather than direct end-to-end vessel repair.
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Affiliation(s)
- David Chwei-Chin Chuang
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsing Street, Kuei-Shan, Taoyuan 33305, Taiwan.
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