Focal Nerve Trauma

  • Götz Penkert
Chapter

Abstract

A brief survey is given of how to deal with nerve trauma. First, the important Sunderland classification of the five possible degrees of nerve lesion is outlined; second, the reaction of connected tissue within and around the nerve as a secondarily disturbing factor is discussed. The time span between nerve injury and potential or expected regeneration signs is argued to remain the main problem when dealing with nerve trauma. For the investigation of regeneration, we always emphasize to elicit the Tinel sign which slowly moves downwards with growing axon sprouts. By means of modern high resolution ultrasound, a neuroma in continuity or a stump neuroma will be detected perhaps more frequently and earlier. Therefore, our hope is expressed that easily available imaging techniques will influence our decision making in future.

Principles and techniques of nerve repair by autologous grafts are then described followed by special remarks on the ongoing challenge to improve the property of artificial implants. Finally, comments are made on positive and negative arguments regarding the application of postoperative electric muscle stimulation.

Keywords

Neuroma 

References

  1. 1.
    Richter H-P. Reinnervation of skeletal muscle. Zent bl Neurochir. 1991;52:109–17.Google Scholar
  2. 2.
    Gordon T, Tyreman N, Raji MA. The basis for diminished functional recovery after delayed peripheral nerve repair. J Neurosci. 2011;31(14):5325–34.PubMedCrossRefGoogle Scholar
  3. 3.
    Kline DG, Hudson AR. Nerve injuries. Philadelphia: Saunders; 1995. p. 101–15.Google Scholar
  4. 4.
    Koenig RW, Schmidt TE, Heinen CP, et al. Intraoperative high-resolution ultrasound: a new technique in the management of peripheral nerve disorders. J Neurosurg. 2011;114(2):514–21.PubMedCrossRefGoogle Scholar
  5. 5.
    Millesi H. Internal neurolysis. In: Gorio A, editor. Posttraumatic peripheral nerve regeneration: experimental basis and clinical implications. New York: Raven Press; 1981. p. 197–210.Google Scholar
  6. 6.
    Millesi H, Meissl G, Berger A. Further expriences with interfascicular grafting of median, ulnar, and radial nerves. J Bone Joint Surg. 1976;58A(2):209–18.Google Scholar
  7. 7.
    Foerster O. Münch med Wschr 1916;63:283.Google Scholar
  8. 8.
    Gohritz A, Dellon LA, Guggenheim M, Spies M, Steiert A, Vogt PM. Otfried Foerster (1873–1941) - self-taught neurosurgeon and innovator of reconstructive peripheral nerve surgery. J Reconstr Microsurg. 2013;29(1):33–43.PubMedGoogle Scholar
  9. 9.
    Jacobsen HJ. Microsurgical technique in the repair of traumatized extremity. Clin Orthop. 1963;29:132–45.Google Scholar
  10. 10.
    Penkert G, Fansa H. Peripheral nerve lesions. Berlin: Springer; 2004. p. 11–9, 69–109.CrossRefGoogle Scholar
  11. 11.
    Weiss P, Taylor C. The viability of isolated nerve fragments and its modification by methylene blue. J Cell Comp Physiol. 1946;27:87–103.CrossRefGoogle Scholar
  12. 12.
    Penkert G, Bini W, Samii M. Revascularistion of nerve grafts. An experimental study. J Reconstr Microsurg. 1988;4(4):319–25.PubMedCrossRefGoogle Scholar
  13. 13.
    Haastert K, Mauritz C, Matthies C, Grothe C. Autologous adult human Schwann cells genetically modified to provide alternative cellular transplants in peripheral nerve regeneration. J Neurosurg. 2006;104:778–86.PubMedCrossRefGoogle Scholar
  14. 14.
    Haastert K, Lipokatic E, Fischer M, Timmer M, Grothe C. Differentially promoted peripheral nerve regeneration by grafted Schwann cells over-expressing different FGF-2 isoforms. Neurobiol Dis. 2006;21(1):138–53.PubMedCrossRefGoogle Scholar
  15. 15.
    Keillhoff G, Stang F, Goihl A, Wolf G, Fansa H. Transdifferentiated mesenchymal stem cells as alternative therapy in supporting nerve regeneration and myelination. Cell Mol Neurobiol. 2006;26(7/8):1235–52.Google Scholar
  16. 16.
    Nix WA, Dahm M. The effect of isometric short-term electrical stimulation on denervated muscle. Muscle Nerve. 1987;10:136–43.PubMedCrossRefGoogle Scholar
  17. 17.
    Haastert-Tallini K, Schmitte R, Korte N, Klode D, Ratzke A, Grothe C. Electrical stimulation accelerates axonal and functional peripheral nerve regeneration across long gaps. J Neurotrauma. 2011;28(4):661–74.CrossRefGoogle Scholar
  18. 18.
    Gordon T, Brushart TM, Amirjani N, Chan KM. The potential of electrical stimulation to promote functional recovery after peripheral nerve injury – comparisons between rats and humans. Acta Neurochir Suppl. 2007;100:3–11.PubMedCrossRefGoogle Scholar
  19. 19.
    Sinis N, Horn F, Genchev B, et al. Electrical stimulation of paralyzed vibrissal muscles reduces endplate reinnervation and does promote motor recovery after facial nerve repair in rats. Ann Anat. 2009;191:356–70.PubMedCrossRefGoogle Scholar
  20. 20.
    Angelov D, Ceynowa M, Guntinas-Lichius O, et al. Mechanical stimulation of paralyzed vibrissal muscles following facial nerve injury in adult rat promotes full recovery of whisking. Neurobiol Dis. 2007;26:229–42.PubMedCrossRefGoogle Scholar
  21. 21.
    Bendella H, Pavlov SP, Grosheva M, et al. Non-invasive stimulation of the vibrissal pad improves recovery of whisking function after simultaneous lesion of the facial and infraorbital nerves in rats. Exp Brain Res. 2011;212:65–79.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Götz Penkert
    • 1
  1. 1.Neurosurgical DepartmentFriederiken-HospitalHannoverGermany

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