[Clinical use of a new method in microsurgical transplantation of peripheral nerves]

Due to its biophysical properties the CO2-laser has been mainly used for atraumatic incision of neural tissue or for ablative procedures like vaporisation of poorly vascularized tumors of the CNS. The possibility to use the thermal effect of laser energy to bond organic tissue, especially when a low energy CO2 laser working in the milliwatt range is employed, has emerged from recent experimental studies. The concept of laser assisted reconstructive procedures like anastomosis of vessels and nerves has been summarized under the concept of tissue welding. After extensive experimental studies incorporating peripheral and cranial nerves the technique of laser nerve welding has been used in a patient with a traumatically sectioned median nerve. A sural nerve graft consisting of 5 fasciles was used for interposition. Each fascicle was microsurgically welded to the distal and proximal median nerve stump using low power energy of 75 to 100 milliwatt in the continuous application mode. The postoperative course was uneventful. Electrophysiological as well as clinical examination at follow up 6 months post surgery revealed already satisfactory nerve regeneration with nerve conduction velocities measurable across the anastomotic side and positive Hoffmann-Tinel sign. It is suggested that laser assisted nerve anastomosis using the CO2 milliwattlaser might be a promising technique for microsurgical reconstruction of sectioned nerves.