Clinical results and thoughts on sensory nerve repair by autologous vein graft in emergency hand reconstruction.
Lesions of the digital and other sensory nerves in the hand are common. Based on experimental studies on vein graft as a support for peripheral nerve regeneration, the Authors have been using a simple vein graft to bridge sensory nerve gaps when treating acute hand injuries. This is a retrospective study on the results of 22 sensory nerves repaired using vein grafts in cases in which primary suture was not feasible, in emergency hand reconstruction. Patients were informed that a secondary nerve graft could possibly be necessary in the future. Patients were reviewed by two independent observers at least one year after repair and evaluated using the Highest scale as modified by MacKinnon & Dellon. Evaluation chart included influence of repair on rehabilitation program and presence of painful neuromas and scars as well as patient satisfaction. Results were classified according to Sakellarides and 20/22 were classified as very good or good. Cases classified as poor were satisfied and no secondary nerve grafting has been carried out. Rehabilitation of the associated lesions (tendon lacerations or bone and soft tissue damage) was not influenced by the nerve repair and no painful neuroma was reported in the series. In conclusion, since the literature shows unsatisfactory results in repair of digital nerves with nerve grafts, since it's been demonstrated that an unrepaired sensory nerve leads to painful scar and painful neuroma and since we are reluctant to use nerve grafts in emergency procedures, we recommend this simple method because it is easy, low-cost and effective.
Gruppo Interdisciplinare di Chirurgia della Mano, Dipartimento delle Specialità Chirurgiche, Università di Messina, Italie. grisitano@unime.it
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Risitano
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Cavallaro
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Merrino
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Coppolino
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Ruggeri
D000293:Adolescent; D000328:Adult; D000368:Aged; D004638:Emergency Treatment; D005260:Female; D006225:Hand / Q000294:innervation; D006230:Hand Injuries / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009416:Nerve Regeneration; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014680:Veins / Q000637:transplantation*