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[Late results after nerve transplantation on the upper extremities]
A Renner1, F Cserkuti, J Hankiss
1Zentralinstitut für Traumatologie und Notfälle, Abteilung für Hand- und Mikrochirurgie, Budapest, Hungary. rennerhand@axelero.hu
Purpose:
The purpose of this retrospective study was to determine the influence of the type of injury, the time elapsed after the injury, the blood supply to the operation area, the size of the graft, and the applied treatment method on the late results.
Method And Material:
In the study period from 1985 through 2000, nerve transplantations had been performed in 281 patients. There were 204 men and 77 women. Reconstructions were applied on the median nerve in 59 patients, ulnar nerve in 48, median and ulnar nerves in 23, radial nerve in ten, and digital nerves in 141 patients. 188 patients presented for late follow-up (66.9%).
Results:
Evaluation was made according to the Highet scheme. In patients with median nerve transplantation M(3) or better results were seen in 69%, with M(3) being 45.2%. S(3) or better was observed in 64.3%, with S(3) being 47.6%. In patients after ulnar nerve transplantation M(3) or better result was achieved in 56.8%, M(3) being 19%. S(3) or better result was seen in 32.4%, S(3) being 27%. In patients who underwent median and ulnar nerve transplantations M(3) or better result was seen in 36.8%, M(3) being 26.3%. S(3) was in 42.1%, while S(4) did not occur. In patients after radial nerve transplantation M(3) or better effect resulted in 87.5%, M(3) being 12.5%. In patients with digital nerve transplantation S(3) or better result occurred in 57.4 %, S(3) being 47.6%.
Conclusion:
The best result can be achieved with nerve suturing, performed as an optimum from all aspects. However, as far as the surgical technique is concerned, results of using interfascicular grafts are more advantageous than epineural nerve suture based on compromises. In ideal circumstances, transplantation of a nerve graft less than 2 cm is of the same value as a good primary suture. If a nerve graft is longer than 2 cm, and negative local factors are accumulating due to the type of injury, late results will gradually deteriorating. The final outcome definitely depends on the patient's age and the time elapsed from the injury to the operation.