Zusammenfassung
Schon bei einfachen Unfallmechanismen (z. B. glatte Schnittverletzungen) kann es zu Verletzungen von nervalen Strukturen kommen, häufig vor allem im Bereich der Finger. Diese lassen sich in vielen Fällen im Rahmen der Primärversorgung durch primäre, spannungsfreie mikrochirurgische Nervenkoaptation operativ erfolgreich versorgen.
Darüber hinaus gibt es jedoch Situationen, bei denen dieses Vorgehen nicht möglich ist – sei es aufgrund der Verletzungsschwere, die mit einem Weichteil- und Nervendefekt einhergeht, oder beispielsweise nach Tumorresektionen, die auch die Entfernung peripherer Nerven erforderten. Auch primär nicht diagnostizierte Nervenläsionen entziehen sich in den meisten Fällen einer spätprimären direkten Koaptation.
In diesen Fällen besteht prinzipiell die Indikation zur sekundären Nervenrekonstruktion, für die verschiedene Techniken zur Verfügung stehen. Goldstandard ist die autogene Nerventransplantation. Einen Stellenwert besitzen aber auch die Rekonstruktionen mit künstlichen Nervenröhrchen, Nerventransfers oder alternative Techniken wie die End-zu-Seit-Koaptation oder die direkte Neurotisation.
Abstract
Simple accidental injuries (like cutting wounds) may already lead to laceration of peripheral nerves, especially in the fingers. These nerve injuries can be treated successfully in most cases by a primary, tension-free microsurgical coaptation.
However, there are situations in which this might not be possible, for example, due to crush injuries with loss of soft tissues and resulting nerve gaps or after tumor resection including critical nerves. Even nerve injuries missed primarily usually cannot be coaptated secondarily in a direct manner. In these cases, there is an indication for secondary nerve reconstruction, which can be performed by various techniques such as autologous nerve transplantation, artificial nerve tubes, nerve transfers or alternative techniques such as end-to-side coaptation or direct neurotization.
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Stang, F., Mailänder, P. & Siemers, F. Prinzipien der Nervenrekonstruktion an der oberen Extremität. Obere Extremität 7, 76–82 (2012). https://doi.org/10.1007/s11678-012-0160-6
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DOI: https://doi.org/10.1007/s11678-012-0160-6