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Improving outcomes in traumatic peripheral nerve injuries to the upper extremity

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Peripheral nerve lesions of the upper extremity are common and are associated with devastating limitations for the patient. Rapid and accurate diagnosis of the lesion by electroneurography, neurosonography, or even MR neurography is important for treatment planning. There are different therapeutic approaches, which may show individual differences depending on the injured nerve. If a primary nerve repair is not possible, several strategies exist to bridge the gap. These may include autologous nerve grafts, bioartificial nerve conduits, or acellular nerve allografts. Tendon and nerve transfers are also of major importance in the treatment of nerve lesions in particular with long regeneration distances. As a secondary reconstruction, in addition to tendon transfers, there is also the option for free functional muscle transfer. In amputations, the prevention of neuroma is of great importance, for which different strategies exist, such as target muscle reinnervation, regenerative peripheral nerve interface, or neurotized flaps. In this article, we give an overview of the latest methods for the therapy of peripheral nerve lesions.

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Abbreviations

ADM:

Abductor digiti minimi

AIN:

Anterior interosseous nerve

ALT:

Anterolateral thigh

ANA:

Acellular nerve allograft

ANG:

Autologous nerve graft

APB:

Abductor pollicis brevis

BR:

Brachioradialis

CE:

Conformité Européenne

DASH:

Disabilities of the arm, shoulder, and hand

DIEP:

Deep inferior epigastric perforator

ECRB:

Extensor carpi radialis brevis

ECRL:

Extensor carpi radialis longus

EDC:

Extensor digitorum communis

EN:

Electroneurography

EPL:

Extensor pollicis longus

FCR:

Flexor carpi radialis

FCU:

Flexor carpi ulnaris

FDA:

Food and Drug Administration

FDP:

Flexor digitorum profundus

FDS:

Flexor digitorum superficialis

LAF:

Lateral arm flap

MRN:

Magnetic resonance neurography

NS:

Neurosonography

PL:

Palmaris longus

PNI:

Peripheral nerve injury

RPNI:

Regenerative peripheral nerve interface

TMR:

Targeted muscle reinnervation

VDMT:

Vascularized denervated muscle target

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Authors and Affiliations

  1. Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany

    Kim S. Zimmermann, Martin Aman, Leila Harhaus & Arne H. Boecker

  2. Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany

    Kim S. Zimmermann, Martin Aman, Leila Harhaus & Arne H. Boecker

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  1. Kim S. Zimmermann
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Correspondence to Arne H. Boecker.

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This manuscript belongs to the Special Issue of ESOT “Current Practice and International Perspectives in Replantation and Microvascular Reconstruction in Upper Extremity Traumatic Amputation”.

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Zimmermann, K.S., Aman, M., Harhaus, L. et al. Improving outcomes in traumatic peripheral nerve injuries to the upper extremity. Eur J Orthop Surg Traumatol (2023). https://doi.org/10.1007/s00590-023-03751-3

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