Skip to main content
SpringerLink
Log in

Current concepts in peripheral nerve surgery

  • General Review • UPPER LIMB - LOWER LIMB
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

The injuries of the peripheral nerves are relatively frequent. Some of them may lead to defects which cannot be repaired with direct end-to-end repair without tension. These injuries may cause function loss to the patient, and they consist a challenge for the treating microsurgeon. Autologous nerve grafts remain the gold standard for bridging the peripheral nerve defects. Nevertheless, there are selected cases where alternative types of nerve reconstruction can be performed in order to cover the peripheral nerve defects. In all these types of reconstruction, the basic principles of microsurgery are necessary and the surgeon should be aware of them in order to achieve a successful reconstruction. The purpose of the present review was to present the most current data concerning the surgical options available for bridging such defects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Hill C, Riaz M, Mozzam A, Brennen MD (1998) A regional audit of hand and wrist injuries. A study of 4873 injuries. J Hand Surg 23(2):196–200. https://doi.org/10.1016/S0266-7681(98)80174-5

    Article  CAS  Google Scholar 

  2. Mitsiokapa E, Mavrogenis AF, Drakopoulos D, Mauffrey C, Scarlat M (2017) Peroneal nerve palsy after ankle sprain: an update. Eur J Orthop Surg Traumatol Orthop Traumatol 27(1):53–60. https://doi.org/10.1007/s00590-016-1845-0

    Article  Google Scholar 

  3. Macdonald J, McMahon SE, O’Longain D, Acton JD (2018) Delayed sciatic nerve compression following hamstring injury. Eur J Orthop Surg Traumatol Orthop Traumatol 28(2):305–308. https://doi.org/10.1007/s00590-017-2029-2

    Article  CAS  Google Scholar 

  4. Rasulic L (2017) Current concept in adult peripheral nerve and brachial plexus surgery. J Brachial Plexus Peripher Nerv Injury 12(1):e7–e14. https://doi.org/10.1055/s-0037-1606841

    Article  Google Scholar 

  5. Millesi H (1981) Interfascicular nerve grafting. Orthop Clin N Am 12(2):287–301

    CAS  Google Scholar 

  6. Campbell WW (2008) Evaluation and management of peripheral nerve injury. Clin Neurophysiol: Off J Int Fed Clin Neurophysiol 119(9):1951–1965. https://doi.org/10.1016/j.clinph.2008.03.018

    Article  Google Scholar 

  7. Roganovic Z, Petkovic S (2004) Missile severances of the radial nerve. Results of 131 repairs. Acta Neurochir 146(11):1185–1192. https://doi.org/10.1007/s00701-004-0361-x

    Article  CAS  PubMed  Google Scholar 

  8. Lundborg G, Dahlin L, Danielsen N, Zhao Q (1994) Trophism, tropism, and specificity in nerve regeneration. J Reconstr Microsurg 10(5):345–354. https://doi.org/10.1055/s-2007-1006604

    Article  CAS  PubMed  Google Scholar 

  9. Siemionow M, Brzezicki G (2009) Chapter 8: current techniques and concepts in peripheral nerve repair. Int Rev Neurobiol 87:141–172. https://doi.org/10.1016/s0074-7742(09)87008-6

    Article  CAS  PubMed  Google Scholar 

  10. Fowler JR, Lavasani M, Huard J, Goitz RJ (2015) Biologic strategies to improve nerve regeneration after peripheral nerve repair. J Reconstr Microsurg 31(4):243–248. https://doi.org/10.1055/s-0034-1394091

    Article  PubMed  Google Scholar 

  11. Kouyoumdjian JA (2006) Peripheral nerve injuries: a retrospective survey of 456 cases. Muscle Nerv 34(6):785–788. https://doi.org/10.1002/mus.20624

    Article  Google Scholar 

  12. Noble J, Munro CA, Prasad VS, Midha R (1998) Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma 45(1):116–122

    Article  CAS  Google Scholar 

  13. Seddon HJ (1942) A classification of nerve injuries. BMJ 2(4260):237–239

    Article  CAS  Google Scholar 

  14. Sunderland S (1951) A classification of peripheral nerve injuries producing loss of function. Brain: A J Neurol 74(4):491–516. https://doi.org/10.1093/brain/74.4.491

    Article  CAS  Google Scholar 

  15. Ferrante MA (2018) The assessment and management of peripheral nerve trauma. Curr Treat Options Neurol 20(7):25. https://doi.org/10.1007/s11940-018-0507-4

    Article  PubMed  Google Scholar 

  16. Mackinnon S, Dellon A (1988) Classification of nerve injuries as the basis of treatment. Surgery of the peripheral nerve. New York: Thieme: pp 35–63

  17. Panagopoulos GN, Megaloikonomos PD, Mavrogenis AF (2017) The present and future for peripheral nerve regeneration. Orthopedics 40(1):e141–e156. https://doi.org/10.3928/01477447-20161019-01

    Article  PubMed  Google Scholar 

  18. Hirasawa Y (1996) Peripheral nerve suture. J Orthop Sci 1(3):214–229. https://doi.org/10.1007/BF02349820

    Article  Google Scholar 

  19. Kline DG, Hudson AR, Bratton BR (1981) Experimental study of fascicular nerve repair with and without epineurial closure. J Neurosurg 54(4):513–520

    Article  CAS  Google Scholar 

  20. Snyder C (1981) Epineurial repair. Orthop Clin N Am 12(2):267

    Article  CAS  Google Scholar 

  21. Sunderland S (1968) Nerves and nerve in juries. E& S Livingstone Ltd, Edinburgh

    Google Scholar 

  22. Hakstian RW (1968) Funicular orientation by direct stimulation. An aid to peripheral nerve repair. J Bone Joint Surg Am Vol 50(6):1178–1186

    Article  CAS  Google Scholar 

  23. Leung P-C, Gu Y, Ikuta Y (1995) Microsurgery in orthopaedic practice. World Scientific

  24. Millesi H, Meissl G, Berger A (1972) The interfascicular nerve-grafting of the median and ulnar nerves. J Bone Joint Surg Am Vol 54(4):727–750

    Article  CAS  Google Scholar 

  25. Jebson PJ, Kasdan ML (2006) Hand secrets. Elsevier Health Sciences, Amsterdam

    Google Scholar 

  26. Seddon H (1972) Surgical disorders of the peripheral nerves. Churchill Livingstone, Edinburgh

    Google Scholar 

  27. Millesi H (2000) Techniques for nerve grafting. Hand Clin 16(1):73–91

    CAS  PubMed  Google Scholar 

  28. Taylor GI, Ham FJ (1976) The free vascularized nerve graft: a further experimental and clinical application of mecrovascular techniques. Plast Reconstr Surg 57(4):413–426

    Article  CAS  Google Scholar 

  29. Slutsky DJ (2005) A practical approach to nerve grafting in the upper extremity. Atlas Hand Clin 10:73–92. https://doi.org/10.1016/j.ahc.2004.09.005

    Article  Google Scholar 

  30. Ray WZ, Mackinnon SE (2010) Management of nerve gaps: autografts, allografts, nerve transfers, and end-to-side neurorrhaphy. Exp Neurol 223(1):77–85. https://doi.org/10.1016/j.expneurol.2009.03.031

    Article  PubMed  Google Scholar 

  31. Muheremu A, Ao Q (2015) Past, present, and future of nerve conduits in the treatment of peripheral nerve injury. Biomed Res Int 2015:237507. https://doi.org/10.1155/2015/237507

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Geuna S, Tos P, Titolo P, Ciclamini D, Beningo T, Battiston B (2014) Update on nerve repair by biological tubulization. J Brachial Plexus Peripher Nerv Inj 9(1):3. https://doi.org/10.1186/1749-7221-9-3

    Article  Google Scholar 

  33. Davis GE, Engvall E, Varon S, Manthorpe M (1987) Human amnion membrane as a substratum for cultured peripheral and central nervous system neurons. Dev Brain Res 33(1):1–10. https://doi.org/10.1016/0165-3806(87)90170-2

    Article  Google Scholar 

  34. Kokkalis ZT, Mavrogenis AF, Ballas EG, Papagelopoulos PJ, Soucacos PN (2015) Collagen nerve wrap for median nerve scarring. Orthopedics 38(2):117–121. https://doi.org/10.3928/01477447-20150204-04

    Article  PubMed  Google Scholar 

  35. Ramburrun P, Kumar P, Choonara YE, Bijukumar D, du Toit LC, Pillay V (2014) A review of bioactive release from nerve conduits as a neurotherapeutic strategy for neuronal growth in peripheral nerve injury. BioMed Res Int. https://doi.org/10.1155/2014/132350

    Article  PubMed  PubMed Central  Google Scholar 

  36. Xie F, Li QF, Gu B, Liu K, Shen GX (2008) In vitro and in vivo evaluation of a biodegradable chitosan-PLA composite peripheral nerve guide conduit material. Microsurgery 28(6):471–479. https://doi.org/10.1002/micr.20514

    Article  PubMed  Google Scholar 

  37. Battiston B, Titolo P, Ciclamini D, Panero B (2017) Peripheral nerve defects: overviews of practice in Europe. Hand Clin 33(3):545–550. https://doi.org/10.1016/j.hcl.2017.04.005

    Article  PubMed  Google Scholar 

  38. Means KR Jr, Rinker BD, Higgins JP, Payne SH Jr, Merrell GA, Wilgis ES (2016) A multicenter, prospective, randomized, pilot study of outcomes for digital nerve repair in the hand using hollow conduit compared with processed allograft nerve. Hand 11(2):144–151. https://doi.org/10.1177/1558944715627233

    Article  PubMed  Google Scholar 

  39. Zhu S, Liu J, Zheng C, Gu L, Zhu Q, Xiang J, He B, Zhou X, Liu X (2017) Analysis of human acellular nerve allograft reconstruction of 64 injured nerves in the hand and upper extremity: a 3 year follow-up study. J Tissue Eng Regen Med 11(8):2314–2322. https://doi.org/10.1002/term.2130

    Article  CAS  PubMed  Google Scholar 

  40. Zyaei A, Saied A (2010) Functional outcome of ulnar nerve fascicle transfer for restoration of elbow flexion in upper brachial plexus injury. Eur J Orthop Surg Traumatol 20(4):293–297. https://doi.org/10.1007/s00590-009-0558-z

    Article  Google Scholar 

  41. Samardzic M, Grujicic D, Rasulic L, Bacetic D (2002) Transfer of the medial pectoral nerve: myth or reality? Neurosurgery 50(6):1277–1282. https://doi.org/10.1097/00006123-200206000-00019

    Article  PubMed  Google Scholar 

  42. Letievant E (1873) Traité des sections nerveuses. JB Baillière et fils, Paris

    Google Scholar 

  43. Lundborg G, Zhao Q, Kanje M, Danielsen N, Kerns J (1994) Can sensory and motor collateral sprouting be induced from intact peripheral nerve by end-to-side anastomosis? J Hand Surg 19(3):277–282. https://doi.org/10.1016/0266-7681(94)90069-8

    Article  CAS  Google Scholar 

  44. Beris AE, Lykissas MG (2009) Chapter 13: experimental results in end-to-side neurorrhaphy. Int Rev Neurobiol 87:269–279. https://doi.org/10.1016/s0074-7742(09)87013-x

    Article  PubMed  Google Scholar 

  45. Beris A, Lykissas M, Korompilias A, Mitsionis G (2007) End-to-side nerve repair in peripheral nerve injury. J Neurotrauma 24(5):909–916. https://doi.org/10.1089/neu.2006.0165

    Article  PubMed  Google Scholar 

  46. Viterbo F, Trindade JC, Hoshino K, Mazzoni A (1994) Two end-to-side neurorrhaphies and nerve graft with removal of the epineural sheath: experimental study in rats. Br J Plast Surg 47(2):75–80. https://doi.org/10.1016/0007-1226(94)90162-7

    Article  CAS  PubMed  Google Scholar 

  47. Lykissas MG, Korompilias AV, Batistatou AK, Mitsionis GI, Beris AE (2007) Can end to side neurorrhaphy bridge large defects? An experimental study in rats. Muscle Nerv 36(5):664–671. https://doi.org/10.1002/mus.20861

    Article  Google Scholar 

  48. Hosseinian MA, Gharibi Loron A, Nemati B, Khandaghy M (2015) Comparison of a distal end-to-side neurorrhaphy with a proximal-distal end-to-side neurorrhaphy: in a rat model. Eur J Orthop Surg Traumatol Orthop Traumatol 25(8):1261–1264. https://doi.org/10.1007/s00590-015-1699-x

    Article  Google Scholar 

  49. Artiaco S, Tos P, Conforti LG, Geuna S, Battiston B (2010) Termino-lateral nerve suture in lesions of the digital nerves: clinical experience and literature review. J Hand Surg Eur 35(2):109–114. https://doi.org/10.1177/1753193409337959

    Article  CAS  Google Scholar 

  50. Mavrogenis AF, Pavlakis K, Stamatoukou A, Papagelopoulos PJ, Theoharis S, Ζhang Z, Soucacos PN, Zoubos AB (2013) Intraneural OX7-saporin for neuroma-in-continuity in a rat model. Eur J Orthop Surg Traumatol 23(3):263–272. https://doi.org/10.1007/s00590-012-0996-x

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Medicine, University of Ioannina, Ioannina, Greece

    Alexandros Beris

  2. Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, Ioannina, Greece

    Ioannis Gkiatas, Ioannis Gelalis, Dimitrios Papadopoulos & Ioannis Kostas-Agnantis

Authors
  1. Alexandros Beris
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ioannis Gkiatas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ioannis Gelalis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dimitrios Papadopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ioannis Kostas-Agnantis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ioannis Gkiatas.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beris, A., Gkiatas, I., Gelalis, I. et al. Current concepts in peripheral nerve surgery. Eur J Orthop Surg Traumatol 29, 263–269 (2019). https://doi.org/10.1007/s00590-018-2344-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-018-2344-2

Keywords

Search

Navigation