The use of vein grafts in upper extremity nerve surgery

Abstract 

Vein grafts have been used to cope with several problems in peripheral nerve surgery, including vein wrapping of scarred nerves involved in chronic pain syndromes, vein caps for recurrent end-stump neuromas, vein conduits for nerve gaps after resection of neuromas-in-continuity, and following trauma. From 1993–1997, 30 vein grafts were performed in 28 patients. Five chronic peripheral nerve pain syndromes were treated by vein wrapping for two ulnar, two median and one radial sensory nerve, with significant pain resolution in all cases. Two recurrent digital neuromas were treated with vein caps, with pain resolution in each case. Nine patients with neuromas-in-continuity underwent neuroma resection and nerve repair with vein conduits. Twelve patients (14 nerves) underwent primary or delayed repair with vein conduits for nerve gaps following trauma. Sensory return measured by two point discrimination after repair of nerve gaps, following either neuroma-in-continuity resections or trauma, was 5–10 mm in 17 digital or common digital nerve injuries, and greater than 10 mm in three radial sensory nerve injuries.