Vein conduit associated with microsurgical suture for complete collateral digital nerve severance

Abstract

The aim of this study is to present the long term results of a series of 53 vein conduit grafts as first line therapy to repair complete severance of one or more collateral digital nerves. The surgical technique included an epi-perineural suture of the nerve under minimal tension, associated with a vein graft harvested from the back of the hand to cover the nerve. None of the patients presented with a neuroma, spontaneous pain or had stopped using the injured finger. Sensibility results were good or very good in 67% of cases. The scar at the donor site was very light or invisible. A total of 96% of patients were satisfied or very satisfied. This simple technique, by protecting the injured nerve, results in a rate of sensory nerve recovery that is comparable or better than that of other series in the literature, without neuroma and with minimal scarring at the donor site.

Comparison of results obtained with standard and inside out vein graft techniques and their implication on neurotrophin expression in repair of nerve defect: An experimental study

“…Both the SVG and IOVG have been used clinically to treat transections in sensory nerves . The results obtained are very similar, with both techniques providing good sensory recovery.…”

Refinements of nerve repair with connector‐assisted coaptation

“…Lundborg, Weber, Boeckstyns, and Zhang al reported increased levels and rates of sensory recovery (Boeckstyns, Sorensen, Vineta, Rosen, Navarro, Archibald, … Krarup, 2013; Lundborg, Rosen, Dahlin, Danielsen, Holmberg, & Sweden, ; Weber, Breidenbach, Brown, Jabaley, & Mass, ; Zhang, Han, Wang, Xue, Kou, Wang, … Jian, 2013). Lundborg and Boeckstyn's reported comparable levels of motor recovery (Boeckstyns, Sorensen, Vineta, Rosen, Navarro, Archibald, … Krarup, 2013; Lundborg, Rosen, Dahlin, Danielsen, Holmberg, & Sweden, ), while Wolfe observed a small trend toward increased rate of motor recovery (Wolfe, Strauss, Garg, & Feinberg, ) and Zhang observed a statistically significant improvement in both the rate and level of motor recovery (Zhang, Han, Wang, Xue, Kou, Wang,… Jian, 2013).4 Reduction in pain was observed with our without detensioning suture if a connector was placed over the coapation (Aberg, Ljunberg, Edin, Millqvist, Nordh, Theorin, Tereneghi, & Wiberg, ; Alligand‐Perrin, Rabarin, Jeudy, Cesari, Saint‐Cast, Fouque, & Raimbeau, ; Arnaout, Fontaine, & Chantelot, ; Boeckstyns, Sorensen, Vineta, Rosen, Navarro, Archibald,… Krarup, 2013; Farole & Jamal, ; Fujita, Tojyo, Yamada, Go, Matsumoto, & Kiga, ; Leuzzi, Armenio, Leone, De Santis, Di Turi, Annoscia, Bufano, & Pascone, ; Lundborg, Rosen, Dahlin, Danielsen, Holmberg, & Sweden, ; Weber, Breidenbach, Brown, Jabaley, & Mass, ; Zhang, Han, Wang, Xue, Kou, Wang,… Jian, 2013). Operative time was consistently found to be less in the connector groups as compared to the direct suture groups, not surprisingly this was more common with off the shelf materials, versus autologous tissue harvest (Aberg, Ljunberg, Edin, Millqvist, Nordh, Theorin, Tereneghi, & Wiberg, ; Alligand‐Perrin, Rabarin, Jeudy, Cesari, Saint‐Cast, Fouque, & Raimbeau, ; Boeckstyns, Sorensen, Vineta, Rosen, Navarro, Archibald,… Krarup, 2013; Fujita, Tojyo, Yamada, Go, Matsumoto, & Kiga, ; Leuzzi, Armenio, Leone, De Santis, Di Turi, Annoscia, Bufano, & Pascone, ; Lundborg, Rosen, Dahlin, Danielsen, Holmberg, & Sweden, ; Weber, Breidenbach, Brown, Jabaley, & Mass, ; Zhang, Han, Wang, Xue, Kou, Wang,… Jian, 2013).…”

“…The tube repair provides protected environment for the nerve coaptation, relocates the sutures away from the coaptation site and coaptation and provides an area for selective reinnervation of the distal tissues. The merit of this technique has been examined in several clinical studies (Aberg, Ljunberg, Edin, Millqvist, Nordh, Theorin, Tereneghi, & Wiberg, ; Alligand‐Perrin, Rabarin, Jeudy, Cesari, Saint‐Cast, Fouque, & Raimbeau, ; Arnaout, Fontaine, & Chantelot, ; Boeckstyns, Sorensen, Vineta, Rosen, Navarro, Archibald,… Krarup, 2013; Farole & Jamal, ; Fujita, Tojyo, Yamada, Go, Matsumoto, & Kiga, ; Leuzzi, Armenio, Leone, De Santis, Di Turi, Annoscia, Bufano, & Pascone, ; Lundborg, Rosen, Dahlin, Danielsen, Holmberg, & Sweden, ; Weber, Breidenbach, Brown, Jabaley, & Mass, ; Wolfe, Strauss, Garg, & Feinberg, ; Zhang, Han, Wang, Xue, Kou, Wang,… Jian, 2013), demonstrating the benefits of a connector‐assisted coaptation over traditional suture. Historical challenges of these techniques were mostly related to poor permeability of the conduit, tissue hyper‐reactivity to nonresorbable foreign material, and an inability to visualize the contents of the nontransparent conduit in order to assess proper fascicular alignment or the presence of a gap.…”

Secondary restoration of fingertip sensation with Littler's heterodigital neurovascular island flap after ring avulsion injury: Report of two cases

“…Paprottka et al [10] looked into sensibility restoration with different techniques and proposed a decision tree based on a meta-analysis of proper palmar digital nerve repair. If tensionless direct suture is not possible and a gap is present, the most appropriate repair technique depends on the gap size; if less than 10 mm: vein graft [11] or neurotube; between 10 and 30 mm: neurotube or posterior interosseous nerve (PIN) graft; more than 30 mm: sural nerve or medial cutaneous forearm nerve graft or end-to-side suture repair [12]. The advantage of these techniques is that they can be performed in a single step.…”