Vein grafts used as nerve conduits for obstetrical brachial plexus palsy reconstruction.
BACKGROUND
Limited availability of donor nerve grafts along with donor-site morbidity has stimulated research toward other alternatives for the repair of severe nerve injuries. The authors provide a comprehensive review of "tubulization" biology and share with the readers their experience with two cases of obstetrical brachial plexus paralysis where they used vein grafts with "minced" nerve tissue, to accomplish connectivity of proximal donors with distal targets. Usage of vascular tissue as conduits for nerve regeneration was first reported more than 100 years ago. It has been suggested that the vein's wall allows diffusion of the proper nutrients for nerve regeneration, acts as a barrier against ingrowth of scar, and prevents wastage of regenerating axons.


METHODS
In this report, vein grafts of 2.4, 3.5, and 22 cm in length filled with minced peripheral nerve tissue were used as bridges in two cases of obstetrical brachial plexus paralysis.


RESULTS
By filling the vein lumen with small pieces of nerve tissue suspended in a heparinized saline solution, a potential problem associated with vein collapse caused by compression was solved.


CONCLUSIONS
The authors suggest that tubulization techniques should be kept in mind in clinical practice when autologous nerve grafts are insufficient for distal target connectivity or as an alternative to conventional nerve grafts for bridging certain nerve defects.
Terzis
Julia K
JK
Norfolk, Va. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, and the Microsurgery Program, Eastern Virginia Medical School, and the International Institute of Reconstructive Microsurgery.
Kostas
Ioannis
I
D020516:Brachial Plexus Neuropathies / Q000209:etiology / Q000601:surgery*; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D007223:Infant; D007367:Intercostal Nerves / Q000601:surgery*; D008297:Male; D009416:Nerve Regeneration; D016067:Nerve Transfer / Q000379:methods*; D009463:Neuroma / Q000209:etiology / Q000601:surgery; D010246:Paralysis, Obstetric / Q000209:etiology / Q000601:surgery*; D011843:Radiculopathy / Q000601:surgery*; D012421:Rupture / Q000601:surgery; D012501:Saphenous Vein / Q000637:transplantation*; D013116:Spinal Cord / Q000601:surgery; D013126:Spinal Nerve Roots / Q000293:injuries / Q000601:surgery*; D016042:Transplantation, Heterotopic