Sekundäre Nervenrekonstruktionen an Extremitäten im Kindesalter - Ergebnisse unter Betrachtung der Anzahl motorischer Einheiten

Abstract

After nerve injury, the therapy of choice is primary suture. If this, however, is not possible or inadequate, a secondary reconstruction must be carried out within a suitable period of time. This study shows results after nerve transplantation within a timeframe of six weeks. Seventeen children with peripheral nerve injuries of the upper extremity were treated. Secondary nerve reconstruction was accomplished by sural nerve transplantation. Eight children, aged from 5 to 13 years, were examined. The median nerve was affected in three and the ulnar nerve in five cases. The examination included clinical and electrophysiological assessments. The length of grafts was correlated with the clinical result. Besides the calculation of sensitive and motor nerve conduction velocity the number of motor units from the flexor pollicis brevis muscle or abductor digiti minimi muscle were determined by motor-unit-estimation (MUE) on both sides. The observation time period was on an average 2.9 years. Results were good to excellent. A persisting Hoffmann-Tinel's sign was found only once in median nerve lesion. Loss of sensitivity following harvesting of sural nerve was not noted as a problem by any of these children. Length of grafts did not affect the results. Standard values were reached in every case in the electrophysiological examination. The number of motor units of the abductor pollicis brevis muscle and abductor digiti minimi muscle decreased to approximately 50% compared to the healthy side. Sural nerve grafting resulted in good motor and sensory function. We recommend grafting within six weeks, as Wallerian degeneration is completed and regeneration from the proximal nerve stump is optimal. Although children have a very good regeneration potential, the examined cases did not achieve a complete restoration of all motor units of the muscles.

Advances of Peripheral Nerve Repair Techniques to Improve Hand Function: A Systematic Review of Literature

“…In this report, the two surgical procedures, referred to as alternative nerve repair techniques by Yuksel et al, [44], are considered to be reasonable treatments for challenging peripheral nerve lesions after both patients regained their protective sensation and returned to work. A study by Lenz-Scharf et al, [45] involving 17 children with upper extremity nerve lesions showed results after nerve transplantation within a timeframe of six weeks. The subjects were treated with sural nerve transplant to median or ulnar nerves and observed for 2.9 years on average [45].…”

“…A study by Lenz-Scharf et al, [45] involving 17 children with upper extremity nerve lesions showed results after nerve transplantation within a timeframe of six weeks. The subjects were treated with sural nerve transplant to median or ulnar nerves and observed for 2.9 years on average [45]. Lenz-Scharf et al, [45] reported good to excellent results.…”

“…The subjects were treated with sural nerve transplant to median or ulnar nerves and observed for 2.9 years on average [45]. Lenz-Scharf et al, [45] reported good to excellent results. They argue that nerve regeneration at the proximal end of the lesion is best within 6 weeks as Wallerian degeneration is complete and nerve grafting should be done within this period [45].…”

“…Lenz-Scharf et al, [45] reported good to excellent results. They argue that nerve regeneration at the proximal end of the lesion is best within 6 weeks as Wallerian degeneration is complete and nerve grafting should be done within this period [45]. However, it is important to note that complete restoration of muscle motor units did not occur in the examined cases [45].…”

“…Seddon [8], however, states that fibrosis at 3 weeks offers a mechanical advantage for nerve suturing. Lenz-Scharf et al, [45] argue that nerve regeneration is best within 6 weeks at the proximal end of the lesion as Wallerian degeneration is complete. Barrios and de Pablos state that the worsening prognosis was related to a time period of longer than 1 year from nerve damage to surgery [48].…”