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Überbrückung peripherer Nervendefekte durch den Einsatz von Nervenröhrchen

Bridging peripheral nerve defects by means of nerve conduits

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Zusammenfassung

Hintergrund

Der Goldstandard zur Überbrückung von Defekten peripherer Nerven ist nach wie vor die autologe Nerventransplantation. In diesem Beitrag wird die alternative Verwendung von Nervenröhrchen zur Rekonstruktion kleinerer Nervendefekte beschrieben. Aktuelle Ergebnisse der Literatur werden ersten Ergebnissen aus unserer Klinik gegenübergestellt.

Patienten und Methoden

Bei 11 Patienten führten wir Nervenrekonstruktionen durch mikrochirurgische Implantation eines Nervenröhrchens durch. Wir beschränkten die Indikation zur Rekonstruktion durch Tubulisation auf Defekte sensibler Nerven von maximal 18 mm Länge. Die Bewertung der Fingersensibilität erfolgte mittels statischer und dynamischer 2-Punkte-Diskrimination (s-, d2PD) und Monofilamenttest 3, 6 und 12 Monate postoperativ.

Ergebnisse

Von 6 Patienten mit einem postoperativen Beobachtungszeitraum von mehr als 12 Monaten wiesen 4 gute Ergebnisse mit einer s2PD von ≤7 mm auf (Highet S4). Ein Patient erreicht keine (S0), ein weiterer lediglich Schutzsensibilität (S3). Monofilamenttest und d2PD bestätigten diese Resultate. Ein vorübergehendes Fremdkörpergefühl wurde bei 3 von 11 Patienten beschrieben und persistierte in 1 Fall.

Schlussfolgerung

Wir beobachteten eine partielle Nervenregeneration über die Nervenröhrchen bei 5 von 6 Patienten. Die Verwendung resorbierbarer Nervenröhrchen stellt bei gegebener Indikation insbesondere wegen der Vermeidung der Spendermorbidität eine mögliche Alternative zur Nerventransplantation dar. Die Technik verlangt wie die autologe Nerventransplantation mikrochirurgische Kenntnisse des Operateurs.

Abstract

Background

The nerve autograft is the gold standard for the reconstruction of peripheral nerve defects. In short gaps, nerve repair by means of tubulization has become an alternative. This technique is discussed based on the current literature and our own experience.

Patients and methods

Nerve reconstruction by means of tubulization was performed in 11 patients. Nerve gaps in the hand of up to 18 mm were reconstructed. Sensibility was assessed using static and dynamic two point discrimination (s-, d2PD) and monofilament testing 3, 6 and 12 months postoperatively.

Results

Three out of 11 patients complained of a temporary foreign body sensation in the area of the implant; this was persistent in one case. Four out of six patients showed excellent results with s2PD of ≤7mm (Highet S4) assessed 12 months postoperatively. One patient regained no (s2PD>15mm, S0), another poor sensibility (s2PD 15mm, S3). D2PD and monofilament testing confirmed these results.

Conclusions

Nerve reconstruction by means of tubulization seems to be a suitable method for certain indications in the reconstruction of short defects of digital and palmar nerves. Donor site morbidity can be avoided. Similarly to nerve transplantation, the operation requires microsurgical skills.

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Interessenkonflikt

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: In früheren Arbeiten wurden Neuragen-Röhrchen für tierexperimentelle Arbeiten zur Verfügung gestellt.

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Authors and Affiliations

  1. Abteilung für Plastische, Hand- und Wiederherstellungschirurgie, Intensiveinheit für Schwerbrandverletzte, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 , Lübeck, Deutschland

    J. Lohmeyer, S. Zimmermann, B. Sommer, H.-G. Machens, T. Lange & P. Mailänder

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  1. J. Lohmeyer
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  2. S. Zimmermann
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  3. B. Sommer
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  4. H.-G. Machens
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  5. T. Lange
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  6. P. Mailänder
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Correspondence to J. Lohmeyer.

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Lohmeyer, J., Zimmermann, S., Sommer, B. et al. Überbrückung peripherer Nervendefekte durch den Einsatz von Nervenröhrchen. Chirurg 78, 142–147 (2007). https://doi.org/10.1007/s00104-006-1269-1

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  • DOI: https://doi.org/10.1007/s00104-006-1269-1

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