Abstract
One century passed before end-to-side neurorrhaphy was rediscovered, and now it finds more frequent use in clinical practice. Experimental studies have improved our understanding of the underlying mechanism and its potential. However, still discussed is whether reinnervation by end-to-side neurorrhaphy works as well in sensory nerves as in motor nerves. The digital nerves are sensory nerves and therefore an ideal model to investigate this question. Two cases of successful sensory reinnervation by end-to-side nerve suture are reported. We began to use end-to-side nerve repair clinically in 1995 and have used it for motor or sensory reinnervation in a total of 13 cases. In two patients primary nerve repair using end-to-side neurorrhaphy was performed in digital avulsion injuries. In one patient the avulsed ulnar nerve of the thumb was sutured end-to-side to the median nerve; in the other the ulnar digital nerve of the ring finger had been destroyed over a distance of 20 mm, and the distal stump was joined end-to-side to the radial nerve of the same finger. Sensory recovery was obtained in both patients. The static two-point discrimination was 3.0 mm, and dynamic two-point discrimination was 2–3 mm for the reinnervated finger compared to 2 mm for static and dynamic two-point discrimination in the adjacent "donor" finger. The sensation of the finger supplied by the "donor nerve" was not altered in relation to the corresponding contralateral finger site. Excellent sensory reinnervation is possible through an end-to-side nerve suture. Proximal avulsion, missing proximal nerve stumps, partial recovery, and prevention of nerve grafts are good indications for resensitization using end-to-side neurorrhaphy. No harm to the donor nerve is expected. Preference should be given to donor nerves that supply skin areas near to the anesthetic area.
Similar content being viewed by others
References
Ballance CA, Ballance HA, Stewart P (1903) Remarks on the operative treatment of chronic facial palsy of peripheral origin. BMJ 1:1009
Dellon AL (1996) Nerve grafting and end-to-side neurorrhaphies connecting phrenic nerve to the brachial plexus. Plast Reconstr Surg 98:905
Giovanoli P, Koller R, Meuli-Simmen C, Rab M, Haslik W, Mittlbock M, Meyer VE, Frey M (2000) Functional and morphometric evaluation of end-to-side neurorrhaphy for muscle reinnervation. Plast Reconstr Surg 106:383
Harris W, Low VW (1903) On the importance of accurate muscular analysis in lesions of the brachial plexus; and treatment of Erb's palsy and infantile paralysis of the upper extremity by cross-union of the nerve roots. BMJ 2:1035
Kayikcioğlu A, Karamursel S, Agaoglu G, Kecik A, Celiker R, Cetin A (2000) End-to-side neurorrhaphies of the ulnar and median nerves at the wrist: report of two cases without sensory or motor improvement. Ann Plast Surg 45:641
Kennedy R (1901) On the restoration of coordinated movement after nerve crossing, with interchange of function of the cerebral cortical centers. Philos Trans R Soc Lond B Biol Sci 194:127
Kostakoglu N (1999) Motor and sensory reinnervation in the hand after an end-to-side median to ulnar nerve coaptation in the forearm. Br J Plast Surg 52:404
Mennen U (1999) End-to-side nerve suture-a technique to repair peripheral nerve injury. S Afr Med J 89:1188
Rapp E, Lallemand S, Ehrler S, Buch N, Foucher G (1999) Restoration of sensation over the contact surfaces of the thumb-index pinch grip using the terminal branches of the superficial branch of the radial nerve. Chir Main 18:179
Santamaria E, Wei FC, Chen IH, Chuang DC (1999) Sensation recovery on innervated radial forearm flap for hemiglossectomy reconstruction by using different recipient nerves. Plast Reconstr Surg 103:450
Sherren J (1906) Some points in the surgery of peripheral nerves. Edinb Med J 20:297
Tham SK, Morrison WA (1998) Motor collateral sprouting through an end-to-side nerve repair. J Hand Surg Am 3:844
Viterbo F, Trindade JC, Hoshino K, Mazzoni Neto A (1992) Latero-terminal neurorrhaphy without removal of the epineural sheath. Experimental study in rats. Rev Paul Med 110:267
Viterbo F, Trindade JC, Hoshino K, Mazzoni Neto A (1994) End-to-side neurorrhaphy with removal of the epineurial sheath: an experimental study in rats. Plast Reconstr Surg 94:1038
Viterbo F, Trindade JC, Hoshino K, Mazzoni A (1994) Two end-to-side neurorrhaphies and nerve graft with removal of the epineural sheath: experimental study in rats. Br J Plast Surg 47:75
Viterbo F, Franciosi LF, Palhares A (1995) Nerve graftings and end-to-side neurorrhaphies connecting the phrenic nerve to the brachial plexus. Plast Reconstr Surg 96:494
Viterbo F, Sanches J, et al (2000) Clinical applications of the end-to-side neurorrhaphy. In: Frey M, Giovanoli P, Koller R (eds) Fifth International Muscle Symposium, Vienna, p 151
Yoleri L, Songur E, Yoleri O, Vural T, Cagdas A (2000) Reanimation of early facial paralysis with hypoglossal/facial end-to-side neurorrhaphy: a new approach. J Reconstr Microsurg 16:347
Yüksel F, Kiṣlaoğlu Ş, et al (1997) End-to-side neurorrhaphy supported by transposed active nerve fibers: Its functional end result in a rat model. Eur J Plast Surg 21:57–62
Zhang F, Cheng C, Chin BT, Ho PR, Weibel TJ, Lineaweaver WC, Buncke HJ (1998) Results of termino-lateral neurorrhaphy to original and adjacent nerves. Microsurgery 18:276
Acknowledgements
We thank Dr. Doris Burg, neurologist at the Division of Reconstructive Surgery at the University Hospital in Zurich, and Dr. Tatjana Paternostro-Sluga, who specializes in electroneurodiagnostic follow-up studies at the Department of Physical Medicine and Rehabilitation at the University of Vienna, for their detailed electroneurodiagnostic studies in our patients. Their work made possible an objective evaluation of the results of end-to-side neurorrhaphy, which was independent of the surgeons treating the patients. We thank Mag. Susanne Friedl for her great help in preparing the manuscript. This research was presented at the 2001 Meeting of the American Society of Reconstructive Microsurgery, Coronado Bay, Calif., 13–16 January, 2001, and at the 11th Annual Meeting of the European Association of Plastic Surgeons, Berlin, 1–3 June 2000.
Author information
Authors and Affiliations
Corresponding author
Additional information
An invited commentary to this paper can be found at http://dx.doi.org/10.1007/s00238-003-0477-x
Rights and permissions
About this article
Cite this article
Frey, M., Giovanoli, P. End-to-side neurorrhaphy of sensory nerves. Eur J Plast Surg 26, 85–88 (2003). https://doi.org/10.1007/s00238-003-0475-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-003-0475-z