DOI: http://dx.doi.org/10.18203/2349-2902.isj20210919

Sensory outcomes after repair of median and ulnar nerve with nerve graft

Ankit Disawal, Sunil Srivastava

Abstract


Background: Peripheral nerve injuries in upper extremities are common. These injuries have significant impact on patient’s life. Appropriate treatment is important for patients to regain functional recovery.

Methods: Study conducted on patients treated on Department of Plastic and Reconstructive surgery from January 2018 to May 2019. Study was done to evaluate the sensory recovery of median and ulnar nerve in the forearm after defects were repair by autologous nerve graft. Evaluation was performed in 24 patients. Rating of sensibility was presented by British medical research council scale. Satisfactory sensory recovery was defined as MRC grading S3+ and S4.

Results: We evaluate the result of  median and ulnar nerve reconstruction as regards to factors affecting functionally the result of operation, which are age, injury level, graft level, and denervation time. Median nerve grafting done in 14 patients and sensory recovery S4 achieved in 2 patients (14%), S3+ in 4 patients (29%). Ulnar nerve grafting done in 10 patients and sensory recovery S4 achieved in 2 patients (20%), S3+ in 2 patients (20%). There was not statistically significant difference in sensory recovery of median and ulnar nerve. There was not statistically significant difference by age, level of injury, graft length, denervation time.

Conclusions: There was no significant difference in sensory recovery of median and ulnar nerves. Mode of injury influences results. Results were comparatively better in younger patients and in patients who had undergone repair within shorter time.

 


Keywords


Autograft, Denervation period, Functional sensation, Nerve reconstruction, Peripheral nerve injury, Recovery

Full Text:

PDF

References


Jaquet JB, Luijsterburg AJ, Kalmin S, Kuypers PD, Hofman A, Hovius SE. Median, ulnar, and combined median-ulnar nerve injuries: functional outcome and return to productivity. J Truma. 2001;51(4):687-92.

Millesi H. Techniques for nerve grafting. Hand clin. 2000;16:73-91.

Beasley RW. Nerve injuries. In: Beasley’s surgery of the hand. 1st edn. New York: Thieme; 2003:252-267.

Allan CH, Vanderhooft E. Functional outcomes after nerve grafting. Atlas Hand Clin. 2005;10:93.

Bruyns CN, Jaquat JB, Schreuders TA, Kalmijn S, Kuypers PD, Hovius SE. Predictors for return to work in patients with median and ulnar nerve injuries. J Hand Surg. 2003;28:28.

Flores AJ, Lavernia CL, Owens PW. Anatomy and physiology of peripheral nerve injury and repair. Am J Orthop. 2000:29:167-73.

Dellon AL, Curtis RM, Edgerton MT. Reeducation of sensation in hand after injury and repair. Plast Reconstr Surg. 1974;53:297.

Moberg E. The unsolved problem: how to test the functional value of hand sensibility. J Hand Ther. 1991;4:105-10.

Dahlin LB, Wiberg M. Nerve injuries of the upper extremity and hand. EFFORT Open Rev. 2017;2:158-70.

Murovic JA. Upper extremity peripheral nerve injuries: A Louisiana state university health sciences center literature review with comparison of the operative outcomes of 1837 median, radial and ulnar nerve lesions. Neurosurgery. 2009;65(4):A11-7.

Vordemvenne T, Langer M, Ochman S, Raschke M, Schult M. Long term results after primary microsurgical repair of ulnar and median nerve injuries: A comparison of common score systems. Clin Neurol Neurosurg. 2007:109:263.

Rujis AC, Jaquet JB, Kalmijn S, Giele H, Hovius SE. Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair. Plast Reconstr Surg. 2005;116:484.

Roganovic Z, Pavlicevic G. Difference in recovery potential of peripheral nerve after graft repairs. Neurosurgery. 2006;59:621.

Battiston B, Lanzetta M. Reconstruction of high ulnar nerve lesion by distal double median to ulnar nerve transfer. J Hand Surg. 1999;24:16.

Kim DH, Han K, Tiel RL, Murovic JA, Kline DG. Surgical outcome of 654 ulnar nerve lesions. J Neurosurg. 2003;98:993.

Roganovic Z. Missile caused ulnar nerve injuries: Outcomes of 128 repairs. Neurosurgery. 2004:55:1120.

Daneyemez M, Solamaz I, Izci Y. Prognostic factors for the surgical management of peripheral nerve lesions. Tohoku J Exp Med. 2005;205:269-75.

Kabak S, Halici M, Baktir A, Turk C, Avsarogullari L. Results of treatment of the extensive volar wrist lacerations’ the spaghetti wrist. Eur J Emerg Med. 2002;9(1):71-6.

Bolitho DG, Boustred M, Hudson DA, Hodgetts KA. Primary epineural repair of the ulnar nerve lesion in children. J Hand Surg. 1999;24:16.