Clinical application of sensory protection of denervated muscle.
Following proximal peripheral nerve injury, motor recovery is often poor due to prolonged muscle denervation and loss of regenerative potential. The transfer of a sensory nerve to denervated muscle results in improved functional recovery in experimental models. The authors here report the first clinical case of sensory protection. Following a total hip arthroplasty, this patient experienced a complete sciatic nerve palsy with no recovery at 3 months postsurgery and profound denervation confirmed electrodiagnostically. He underwent simultaneous neurolysis of the sciatic nerve and saphenous nerve transfers to the tibialis anterior branch of the peroneal nerve and gastrocnemius branch from the tibial nerve. He noted an early proprioceptive response. Electromyography demonstrated initially selective amelioration of denervation potentials followed by improved motor recovery in sensory protected muscles only. The patient reported clinically significant functional improvements in activities of daily living. The authors hypothesize that the presence of a sensory nerve during muscle denervation can improve functional motor recovery.
Bain
James R
JR
Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada. bainj@hhsc.ca
Hason
Yaniv
Y
Veltri
Karen
K
Fahnestock
Margaret
M
Quartly
Caroline
C
D019644:Arthroplasty, Replacement, Hip; D004576:Electromyography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009121:Muscle Denervation; D018482:Muscle, Skeletal / Q000294:innervation*; D009416:Nerve Regeneration / Q000502:physiology; D011183:Postoperative Complications; D020127:Recovery of Function / Q000502:physiology; D012584:Sciatic Nerve / Q000503:physiopathology; D020426:Sciatic Neuropathy / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011984:Sensory Receptor Cells / Q000502:physiology / Q000637:transplantation*