Endoscopically assisted sural nerve harvest for upper extremity posttraumatic nerve defects: an evaluation of functional outcomes.
BACKGROUND
Peripheral nerve injuries in the upper extremity often require interposition of sural nerve grafts for reconstruction. Due to the poor donor-site appearance with standard techniques, and the potential for trauma to the nerve because of poor visualization during the harvest when the stepladder technique is used, the endoscope has been employed for nerve harvest.


METHODS
From January of 1997 until December of 2003, 15 patients with an average age of 27.5 years with posttraumatic upper limb nerve defects of the ulnar, median, or posterior interosseous nerves (crush, cutting, or avulsion injuries) underwent reconstruction with endoscopically harvested sural nerve. The nerves were harvested using atraumatic techniques under video monitor visualization. The functional results of sensation and motor function were assessed using British Medical Research Council scales.


RESULTS
All patients regained at least cutaneous pain and tactile sensibility, with most regaining two-point discrimination (nine patients achieved S3+). Two patients achieved complete recovery (S4). The 11 patients with motor nerve involvement achieved between M1+ and M5 after the initial reconstruction. Eight patients required a total of one immediate and nine secondary procedures to achieve the final outcome. The procedures included tenolysis (three patients), intrinsic tendon transfers (four patients), and opponensplasty (three patients). At the 4-year mean follow-up, grip power was M5 in 13 patients (86.7 percent) and M4 in two patients (13.3 percent).


CONCLUSIONS
Upper extremity sensory and motor nerve defects can be reconstructed with interposition of endoscopically harvested sural nerve grafts. The procedure is reliable, quick, and atraumatic, and results in reasonable motor and sensory recovery.
Lin
Chih-Hung
CH
Division of Trauma, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan. chihhung@cgmh.org.tw
Mardini
Samir
S
Levin
Scott L
SL
Lin
Yu-Te
YT
Yeh
Jiun-Ting
JT
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D013497:Sural Nerve / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D020196:Trauma, Nervous System / Q000601:surgery*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000293:injuries / Q000294:innervation / Q000601:surgery*