Abstract
We reviewed the clinical outcomes of vascularized nerve grafts for the repair of large nerve gaps (longer than 20 cm) after severe trauma to an upper extremity. Six patients who underwent vascularized sural nerve grafting (five to the median nerve and one to the ulnar nerve) with a monitoring skin flap were evaluated. The length of the vascularized sural nerve grafts ranged from 20 to 30 cm, with a mean length of 23.3 cm. All but one of the monitoring skin flap grafts was successful. In those patients for whom the monitoring skin flap graft was successful, the mean static-2PD at the corresponding fingertip was 14.2 mm (range 10–20 mm). Evaluation of these patients with the Semmes-Weinstein test produced the following results: filament 6, two patients; filament 10, three patients. The results of this study show that vascularized sural nerve grafting should be considered as a clinical alternative for nerve reconstruction in patients with nerve defects longer than 20 cm.
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References
Breidenbach WC (1988) Vascularized nerve grafts. Orthop Clin North Am 19:81–89
Breidenbach WC, Terzis JK (1986) The blood supply of vascularized nerve grafts. J Reconstr Microsurg 3:43–57
Bunnell S, Boyes JH (1939) Nerve grafts. Am J Surg 44:64–75
Doi K, Kuwata N, Kawakami F, Tamaru K, Kawai S (1984) The free vascularized sural nerve graft. Microsurgery 5:175–184
Doi K, Kuwata N, Sakai K, Tamaru K, Kawai S (1987) A reliable technique of free vascularized sural nerve grafting and preliminary results of clinical applications. J Hand Surg Am 12:677–684
Doi K, Tamaru K, Sakai K, Kuwata N, Kurafuji Y, Kawai S (1992) A comparison of vascularized and conventional sural nerve grafts. J Hand Surg Am 17:670–676
Gilbert A (1984) Vascularized sural nerve graft. Clin Plast Surg 11:73–77
Klar E (1943) Über Erfahrungen und Erfolge bei Anwendung plastischen Überbrückung von Defekten in peripheren Nerven. Z Neurol Psychist 176:533–555
Koshima I, Harii K (1985) Experimental study of vascularized nerve grafts: multifactorial analyses of axonal regeneration of nerves transplanted into an acute burn wound. J Hand Surg Am 10:64–72
Koshima I, Okumoto K, Umeda N, Moriguchi T, Ishii R, Nakayama Y (1996) Free vascularized deep peroneal nerve grafts. J Reconstract Microsurg 12:131–141
Pho RWH, Lee YS, Rujiwetpongstorn V, Pang M (1985) Histological studies of vascularized nerve graft and conventional nerve graft. J Hand Surg Br 10:45–48
Riordan CL, Nanney LB, Upton J, Wolfort SF (2002) Vascularized medial sural cutaneous nerve based on the superficial sural artery: a reliable nerve graft. J Reconstr Microsurg 18:147–152
Seddon HJ (1947) The use of autologous grafts for the repair of large gaps in peripheral nerves. Br J Surg 35:151–167
Tamura K (1969) The funicular pattern of Japanese peripheral nerves. Nippon Geka Hoka 38:35–85
Tarlov IM, Epstein JA (1945) Nerve grafts: the importance of an adequate blood supply. J Neurosurg 2:49–71
Taylor GI, Ham FJ (1976) The free vascularized nerve graft, a further experimental and clinical application of microvascular technique. Plast Reconstr Surg 57:413–426
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Hasegawa, T., Nakamura, S., Manabe, T. et al. Vascularized nerve grafts for the treatment of large nerve gap after severe trauma to an upper extremity. Arch Orthop Trauma Surg 124, 209–213 (2004). https://doi.org/10.1007/s00402-003-0617-6
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DOI: https://doi.org/10.1007/s00402-003-0617-6