Fascicular shifting: a novel technique to overcome large nerve defects

Hader, Maria; Sporer, Matthias E.; Roche, Aidan D.; Unger, Ewald; Bergmeister, Konstantin D.; Wakolbinger, Robert

doi:10.3171/2017.3.spine16276

Cited by 5 publications

(14 citation statements)

References 34 publications

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“…Furthermore, the composition of motor and sensory fibers is maintained, as proven by histochemical analysis. 20 Partial gap because of the "shift" also regenerates well alongside the healthy nerve graft, as elaborated in the animal study. 21 We took a long (8 cm) fascicular graft so that the final length of the nerve made its position beneath the deep muscle fascia with minimal stretch in extension.…”

Section: Dovepressmentioning

confidence: 80%

“…The unsatisfactory result of the nerve conduction study might be caused by the length of graft although the animal study we used as reference achieved successful sensory nerve regeneration in their fascicular shifting procedure. 20 Another suggestion explaining the sensory deficiency was the presence of a dimple on the patient’s sacrum area. Sensory deficits were also encountered by several reports after performing other techniques of nerve repair mentioned earlier, which flags the importance of possible future complications such as plantar ulcers.…”

Section: Discussionmentioning

confidence: 99%

“…The chosen length of fascicular segment was unlike previous reports in other centers which excised a much shorter segment. 20 , 27

Figure 3 Fascicular shifting methods. …”

Section: Case Reportmentioning

confidence: 99%

“…The chosen length of fascicular segment was unlike previous reports in other centers which excised a much shorter segment. 20,27 Skin flaps were sutured with 2/0 absorbable thread, and immediate post-operative measurements showed an angle of 120° in the operated knee, adding a 30° immediate improvement compared with 90° preoperatively. A long leg posterior splint was applied until the wound healed.…”

Section: Case Reportmentioning

confidence: 99%

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Orthopedic Surgical Management of Complicated Congenital Popliteal Pterygium Syndrome: A Case Report

Hasan¹,

Muhammad²,

Cein³

et al. 2023

ORR

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Introduction Popliteal pterygium syndrome (PPS) is a rare autosomal-dominant condition that causes fixed flexion deformity of the knee. The popliteal webbing and shortening of the surrounding soft tissue could limit the functionality of the affected limb unless it is surgically corrected. We reported a case of PPS in a pediatric patient encountered in our hospital. Case A 10-month-old boy came with a congenital abnormally flexed left knee with bilateral undescended testis and syndactyly of the left foot. The left popliteal pterygium extending from the buttock to the calcaneus was observed, with an associated fixed flexion contracture of the knee and equine position of the ankle. Normal vascular anatomy was seen in the angiographic CT scan; therefore, multiple Z-plasty and fibrotic band excision were performed. The sciatic trunk was exposed on the popliteal level, and the fascicular segment was excised from the distal stump and sutured to the proximal stump under the microscope to extend the sciatic nerve for approximately 7 cm. No postoperative complications were reported. Multiple tendons and soft tissue reconstruction were performed when the patient was 2-year-old to correct the adductus and equine deformity of the left foot. Discussion Surgical correction for popliteal pterygium demands staged techniques to deal with the shortened structure. In our case, multiple Z-plasty were performed, and the fibrotic band was excised until its base with meticulous consideration of the underlying neurovascular bundle. Fascicular shifting technique for sciatic nerve lengthening can be considered in unilateral popliteal pterygium with difficulty extending the knee due to shortened sciatic nerve. The unfavorable outcome of nerve conduction disturbance resulting from the procedure may be multifactorial. Still, the existing foot deformity, including a certain degree of pes equinovarus could be treated by multiple soft tissue reconstructions and adequate rehabilitation to achieve the desired outcome. Conclusion Multiple soft tissue procedures resulted in acceptable functional outcomes. However, the nerve grafting procedure is still a challenging task. Further study is required to explore the technique in optimizing the nerve grafting procedure for popliteal pterygium.

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Section: Dovepressmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

“…The chosen length of fascicular segment was unlike previous reports in other centers which excised a much shorter segment. 20 , 27

Figure 3 Fascicular shifting methods. …”

Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

See 2 more Smart Citations

Orthopedic Surgical Management of Complicated Congenital Popliteal Pterygium Syndrome: A Case Report

Hasan¹,

Muhammad²,

Cein³

et al. 2023

ORR

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“…In the context of peripheral nerve reconstruction, a technique called “fascicular shift procedure” (FSP) has recently been described. 29 This approach involves harvesting a fascicle of the target nerve and shifting it into the defect to overcome the peripheral nerve injury. It is coapted in an end-to-end fashion to both proximal and distal nerve ends, thereby bridging the defect.…”

mentioning

confidence: 99%

Successful Treatment of a Painful Neuroma Using Fascicular Shifting in the Ulnar Nerve: A Case Report

Hruby

Sporer

Krusche-Mandl

et al. 2023

J Reconstr Microsurg Open

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The authors report the case of a forty-year old man with an inveterate ulnar nerve neuroma following a laceration injury of his left wrist twenty-three years ago. He presented with a typical ulnar claw-hand deformity and debilitating neuropathic pain in his hand (VAS 8.4). Pre-operative imaging revealed a neuroma of the ulnar nerve at the Guyon’s canal. Moreover, a complete atrophy of all intrinsic hand muscles innervated by the ulnar nerve was present. A Zancolli lasso procedure was performed to reduce the clawing effect. The neuroma was resected producing a nerve defect of five centimeters. Since the injury dated back more than two decades and any motor recovery was deemed impossible at that point, the motor fascicle of the ulnar nerve, i.e. the deep branch, was harvested and used as an autologous nerve graft to bridge the defect. The deep branch fascicle was dissected proximally, harvested and shifted into the defect to be coapted with the superficial branch fascicle in an end-to-end fashion. The presented procedure resulted in satisfying and sustained pain reduction (VAS 2.5) at two-year follow-up. Hence, the authors recommend considering fascicular shift procedure in peripheral sensory nerve reconstruction as a cost-effective alternative.

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Brachial plexus bridging with specific extracellular matrix-modified chitosan/silk scaffold: a new expand of tissue engineered nerve graft

Song

Guo

et al. 2022

J. Neural Eng.

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Objective. Brachial plexus injuries result in serious dysfunction and are currently treated using autologous nerve graft (autograft) transplantation. With the development of tissue engineering, tissue engineered nerve grafts (TENGs) have emerged as promising alternatives to autografts but have not yet been widely applied to the treatment of brachial plexus injuries. Herein, we developed a TENG modified with extracellular matrix (ECM) generated by skin-derived precursor Schwann cells (SKP-SCs) and expand its application in upper brachial plexus defects in rats. Approach. SKP-SCs were co-cultured with chitosan neural conduits or silk fibres and subjected to decellularization treatment. Ten bundles of silk fibres (five fibres per bundle) were placed into a conduit to obtain the TENG, which was used to bridge an 8 mm gap in the upper brachial plexus. The efficacy of this treatment was examined for TENG-, autograft- and scaffold-treated groups at several times after surgery using immunochemical staining, behavioural tests, electrophysiological measurements, and electron microscopy. Main results. Histological analysis conducted two weeks after surgery showed that compared to scaffold bridging, TENG treatment enhanced the growth of regenerating axons. Behavioural tests conducted four weeks after surgery showed that TENG-treated rats performed similarly to autograft-treated ones, with a significant improvement observed in both cases compared with the scaffold treatment group. Electrophysiological and retrograde tracing characterisations revealed that the target muscles were reinnervated in both TENG and autograft groups, while transmission electron microscopy and immunohistochemical staining showed the occurrence of the superior myelination of regenerated axons in these groups. Significance. Treatment with the developed TENG allows the effective bridging of proximal nerve defects in the upper extremities, and the obtained results provide a theoretical basis for clinical transformation to expand the application scope of TENGs.

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Fascicular shifting: a novel technique to overcome large nerve defects

Cited by 5 publications

References 34 publications

Orthopedic Surgical Management of Complicated Congenital Popliteal Pterygium Syndrome: A Case Report

Orthopedic Surgical Management of Complicated Congenital Popliteal Pterygium Syndrome: A Case Report

Successful Treatment of a Painful Neuroma Using Fascicular Shifting in the Ulnar Nerve: A Case Report

Brachial plexus bridging with specific extracellular matrix-modified chitosan/silk scaffold: a new expand of tissue engineered nerve graft

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