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Mechanical loading of peripheral nerves during remobilisation of the affected member after end-to-end anastomosis

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Summary

Our study involved simulating end-to-end neurorrhaphy of the sciatic nerve in a number of rabbits and analysing in vivo the mechanical loads acting on the nerve while the affected member was being remobilised. We found both the suture and mobilisation loads to be related to the size of the nerve defect. In each case, traction force, strain, and stress were proportional. The effect which these experimental findings may have on the future use of flexing neighbouring joints as a “manipulative” measure to achieve a tension-free nerve suture will be discussed.

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References

  • Babcock, W. W., A standard technique for operations on peripheral nerves with special reference to the closure of large gaps. Surg. Gynec. Obstet.45 (1927), 364–378.

    Google Scholar 

  • Baron, A., Schreiber, W., Über die direkte Nervenvereinigung bei großen Nervendefekten. Münch. med. Wschr.65 (1918), 446–449.

    Google Scholar 

  • Björkesten, G. af, Suture of war injuries to peripheral nerves: clinical studies of results. Acta chir. scand.95, Suppl. 119 (1947).

  • Bragard, K., Die Nervendehnung als diagnostisches Prinzip ergibt eine Reihe neuer Nervenphänomene. Münch. med. Wschr.76 (1929), 1999–2003.

    Google Scholar 

  • Brunelli, G., Microsurgery in peripheral nerves. 5th Int. Congr. Int. Microsurg. Soc., Bonn,4-7. 10. 1978.

    Google Scholar 

  • Buck-Gramcko, D., Wiederherstellung durchtrennter peripherer Nerven. Chir. Praxis15 (1971), 55–63.

    Google Scholar 

  • - Microsurgery in peripheral nerves. 5th Int. Congr. Int. Microsurg. Soc., Bonn, 4.–7. 10. 1978.

  • Cutler, E. C., Gross, R. E., The surgical treatment of tumours of the peripheral nerves. Ann. Surg.104 (1936), 436–452.

    Google Scholar 

  • Forrester, C. R. G., Peripheral nerve injuries with results of early and delayed suture. Amer. J. Surg.47 (1940), 555–572.

    Google Scholar 

  • Geldmacher, J., Die Wiederherstellung verletzter Nerven. Münch. med. Wschr.111 (1969), 2675–2679.

    Google Scholar 

  • Haftek, J., Stretch injury of peripheral nerve. J. Bone Jt. Surg.52 B (1970), 354–365.

    Google Scholar 

  • —, Autogenous cable nerve grafting instead of end-to-end anastomosis in secondary nerve suture. Acta neurochir. (Wien)34 (1976), 217–221.

    Google Scholar 

  • Hartung, G., Arnold, G., Histomechanische Eigenschaften peripherer Nerven. Nervenarzt44 (1973), 80–84.

    PubMed  Google Scholar 

  • Highet, W. B., Holmes, W., Traction injuries to lateral popliteal nerves and traction injuries to peripheral nerves after suture. Brit. J. Surg.30 (1943), 212–233.

    Google Scholar 

  • —, Sanders, F. K., The effects of stretching nerves after suture. Brit. J. Surg.30 (1943), 355–369.

    Google Scholar 

  • Hoen, T. I., Brackett, C. E., Peripheral nerve lengthening. I. Experimental. J. Neurosurg.13 (1956), 43–62.

    PubMed  Google Scholar 

  • Lehmann, W., Die Chirurgie der peripheren Nervenverletzungen. Berlin-Wien: Urban & Schwarzenberg. 1921.

    Google Scholar 

  • Leriche, R., Des causes d'échéc des sutures nerveuses; moyens d'y pallier. Presse méd.1 (1940), 345–348.

    Google Scholar 

  • Liu, C. T., Benda, C. E., Lewey, F. H., Tensile strength of human nerves. Arch. Neurol. Psychiat. (Chic.)59 (1948), 322–336.

    Google Scholar 

  • Maurer, G., Klinik und Therapie der Verletzungen der peripheren Nerven. In: Neuro-Traumatologie II (Kessel, F. K., Gutmann, L., Maurer, G., eds.). München-Berlin-Wien: Urban & Schwarzenberg. 1971.

    Google Scholar 

  • Michon, J., Masse, P., Der optimale Zeitpunkt für die Nervennaht bei Verletzungen der oberen Extremität. Rev. Chir. orthop.50 (1964), 205–212.

    PubMed  Google Scholar 

  • Millesi, H., Zum Problem der Überbrückung von Defekten peripherer Nerven. Wien. med. Wschr.9/10 (1968), 182–187.

    Google Scholar 

  • —, Wiederherstellung durchtrennter peripherer Nerven und Nerventransplantation. Münch. med. Wschr.111 (1969), 2669–2674.

    Google Scholar 

  • —, Diskussionsbemerkung. Symposium über Verletzungen peripherer Nerven. Kassel-Wilhelmshöhe, 3.–4. 2. 1972. Melsunger med. Mitt.46, Heft 116 (1972), 153.

    Google Scholar 

  • —, Indikation und Technik der autologen und interfaszikulären Nerventransplantation. Symposium über Verletzungen peripherer Nerven. Kassel-Wilhelmshöhe, 3.–4. 2. 1972. Melsunger med. Mitt.46, Heft 116 (1972), 181–188.

    Google Scholar 

  • —, Diskussion über Ergebnisse der interfaszikulären autologen Nerventransplantation. Symposium über Verletzungen peripherer Nerven. Kassel-Wilhelmshöhe, 3.–4. 2. 1972. Melsunger med. Mitt.46, Heft 116 (1972), 203–204.

    Google Scholar 

  • —, Wiederherstellung der Kontinuität nach Durchtrennung peripherer Nerven durch Nervennaht oder Nerventransplantation (Indikation und Technik). Ther. Umsch.32 (1975), 446–452.

    PubMed  Google Scholar 

  • —, Moderne Behandlung von Nervenverletzungen. Zbl. Neurochir.37 (1976), 210–211.

    Google Scholar 

  • Millesi, H., Ganglberger, J., Berger, A., Erfahrungen mit der Mikrochirurgie peripherer Nerven. Chir. plast. reconstr.3 (1967), 47–55.

    Google Scholar 

  • Naffziger, H. C., Methods to secure end-to-end suture of peripheral nerves. Surg. Gynec. Obstet.32 (1921), 193–204.

    Google Scholar 

  • Nicholson, O. R., Seddon, H. J., Nerve repair in civil practice. Results of treatment of median and ulnar nerve lesions. Brit. med. J.2 (1957), 1965.

    Google Scholar 

  • Nigst, H., Die Chirurgie der peripheren Nerven. Stuttgart: Thieme. 1955.

    Google Scholar 

  • Orf, G., Critical resection length and gap distance in peripheral nerves. Acta neurochir. (Wien), Suppl.26 (1978).

  • - Gerhards, H. D., in preparation (1979).

  • Pollard, C. L., Jr., Grantham, E. G., Peripheral nerve surgery. J. Neurosurg.12 (1955), 627.

    PubMed  Google Scholar 

  • Salonen, K. A., Telaranta, T., Vilkki, S., Reconstruction of peripheral nerves. 5th Int. Congr. Int. Microsurg. Soc, Bonn, 4.–7. 10. 1978.

  • Samii, M., Interfaszikuläre autologe Nerventransplantation. Dtsch. Ärzteblatt 1973, Heft19, 1257–1262.

  • —, Kahl, R. I., Klinische Resultate der autologen Nerventransplantationen. Symposium über Verletzungen peripherer Nerven. Kassel-Wilhelmshöhe, 3.–4. 2. 1972. Melsunger med. Mitt.46, Heft 116 (1972), 197–202.

    Google Scholar 

  • —, Wagner, D., Ergebnisse der autologen Nerventransplantationen bei Läsionen kranialer und peripherer Nerven. Ther. Umsch.32 (1975), 453–460.

    PubMed  Google Scholar 

  • —, Wallenborn, R., Tierexperimentelle Untersuchungen über den Einfluß der Spannung auf den Regenerationserfolg nach Nervennaht. Acta neurochir. (Wien)27 (1972), 87–110.

    Google Scholar 

  • Scarff, J. E., The surgical treatment of injuries of the brain, spinal cord and peripheral nerves. Surg. Gynec. Obstet.81 (1945), 405–424.

    Google Scholar 

  • —, Peripheral nerve injuries: Principles of treatment. Med. Clin. N. Amer.42 (1958), 611–640.

    PubMed  Google Scholar 

  • Schäfer, E. R., Die Behandlung der frischen, offenen Nervenverletzungen. Chirurg37 (1966), 67–69.

    PubMed  Google Scholar 

  • Scharizer, E., Problem der Nervennaht. Dtsch. med. Wschr.3 (1969), 132–136.

    Google Scholar 

  • Seddon, H. J., War injuries of peripheral nerves. Brit. J. Surg. (War Surgery Suppl. No. 2-Wounds of extremities) 1948, 325–353.

  • - Peripheral nerve injuries. Med. Res. Council Spec. Rep. Series No. 282, London 1954.

  • Seitelberger, F., Sluga, E., Millesi, H., Meissl, G., Vortrag 21. 11. 1969. Ges. d. Ärzte in Wien; cited by Millesi, H., 1975.

  • Smith, J. M., Microsurgery of peripheral nerves. Plast. reconstr. Surg.33 (1964), 317–329.

    PubMed  Google Scholar 

  • Spurling, R. G., Peripheral nerve injuries in European theatre of operations. Management with special reference to early nerve surgery. J. Amer. med. Ass.129 (1945), 1011–1014.

    Google Scholar 

  • Stoffel, A., Über Nervenmechanik und ihre Bedeutung für die Behandlung der Nervenverletzungen. Münch. med. Wschr.62 (1915), 889–892.

    Google Scholar 

  • Stookey, B., Surgical and mechanical treatment of peripheral nerves. Philadelphia: Saunders Co. 1922.

    Google Scholar 

  • Sunderland, S., Nerves and nerve injuries. Edinburgh-London: Churchill Livingstone. 1972.

    Google Scholar 

  • —, Bradley, K. C., Endoneurial tube shrinkage in the distal segment of a severed nerve. J. comp. Neurol.93 (1950), 411–420.

    PubMed  Google Scholar 

  • — —, Stress-strain phenomena in human peripheral nerve trunks. Brain84 (1961), 102–119.

    Google Scholar 

  • — —, Stress-strain phenomena in human spinal nerve roots. Brain84 (1961), 120–124.

    Google Scholar 

  • — —, Stress-strain phenomena in denervated peripheral nerve trunks. Brain84 (1961), 125–127.

    Google Scholar 

  • Takimoto, G., Über Nervendehnung. Experimentelle und klinische Untersuchung. Mitt. med. Fak. K. jap. Univ.16 (1916), 73–136.

    Google Scholar 

  • Usbeck, W., Nerve suture without tension, a method for repairing transected peripheral nerves. Acta neurochir. (Wien)34 (1976), 215–216.

    Google Scholar 

  • Wagner, H., Operative Beinverlängerung. Chirurg42 (1971), 260–266.

    PubMed  Google Scholar 

  • Whitcomb, B. B., Separation at the suture site as a cause of failure in regeneration of peripheral nerves. J. Neurosurg.3 (1946), 399–406.

    Google Scholar 

  • Woodhall, B., The zone of interior. Chapter 10 in Medical Department, United States Army, Surgery in World War II, Neurosurgery, Vol. 2, Part II, Peripheral nerve injuries (Spurling, R. G., Woodhall, B., Washington, D. C., eds.). US Government Printing Office. 1959.

  • Zumtobel, V., Spätergebnisse der chirurgischen Behandlung peripherer Nervenverletzungen. Diss. Med. Fak., Bonn. 1964.

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Orf, G., Wüst, R. Mechanical loading of peripheral nerves during remobilisation of the affected member after end-to-end anastomosis. Acta neurochir 49, 103–121 (1979). https://doi.org/10.1007/BF01809179

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