SURGICAL TACTICS IN DISTAL LESIONS OF NERVE TRUNKS OF THE UPPER LIMBS
Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Republic of Tajikistan
Objective: Optimization of the results of microsurgical reconstruction of the nerve trunks of the upper limb with their complete anatomical break at the distal level
Methods: The results of reconstructions of 129 nerve trunks of the upper limbs with their complete anatomical break at the distal level, performed in 109 patients from 2012 to 2018 were analyzed.
Results: In an emergency order, 47 patients with injuries of 57 nerve trunks were operated (median nerve – 26, ulnar – 23 and radial – 8), at the level of Zone I there was 14 nerve trunks, Zone II – 26, Zone III – 17 nerve trunks. In all cases, the nerve trunks were restored end-to-end. Patients with emergency lesions showed better results compared with the planned reconstruction. So, the best results were obtained in children after an emergency suture (S4, M5), which amounted to 96.5%; in adults, the percentage of good and excellent results after an emergency reconstruction was 93.7%. The results of the autonervous plasty of the nerves in their results to degrees (S3+, S4; M4-M5) were not inferior to the planned end-to-end seam of the nerve and amounted to 82-85%.
Conclusions: Thus, despite the technical difficulties of identifying damaged nerve trunks at distal levels, in all cases were obtained high functional results. The developed one-step replenishment of the defect in the final segment of the nerve trunk with an autonomic transplant preparation allows not only to restore the previous anatomy but also to shorten the duration of the operation and improve the functional effectiveness of the operations.
Keywords: Upper limb, median nerve, ulnar nerve, radial nerve, distal lesions.
- Abramov VV, Kanyuka EV, Nekhanevich OB. Analiz struktury povrezhdeniy u patsientov s zastarelymi travmami distal’nykh otdelov verkhnikh konechnostey [Analysis of the structure of damage in patients with chronic injuries of the distal upper limbs]. Visnik problem biologii i meditsini. 2014;2(3):101-6.
- Gayvoronskiy AI, Zhurbin EA, Dekan VS, Zheleznyak IS, Alekseev ED, Martynov BV, i dr. Intraoperatsionnoe ul’trazvukovoe issledovanie v khirurgii perifericheskikh nervov verkhney konechnosti [Intraoperative ultrasound in the surgery of peripheral nerves of the upper limb]. Vestnik Rossiyskoy voyenno-meditsinskoy akademii. 2015;2:56-9.
- Gerasimenko MA, Koren MN, Tretyak SI, Zhuk EV. Rezul’taty primeneniya maloinvazivnykh sposobov operativnykh vmeshatel’stv pri travmakh verkhney konechnosti u detey [The results of the use of minimally invasive surgical interventions for injuries of the upper limb in children]. Neotlozhnaya meditsinskaya pomoshch’. 2014;3:22-4.
- Vorobyov AA, Petrukhin AV, Zasypkina OA, Krivonozhkina PS. Klinikoanatomicheskie trebovaniya k aktivnym i passivnym ekzoskeletam verkhney konechnosti [Clinical and anatomical requirements for active and passive exoskeletons of the upper limb]. Volgogradskiy nauchno-meditsinskiy zhurnal. 2014;1:56-61.
- Wojtkiewicz DM, Saunders J, Domeshek L, Novak CB, Kaskutas V, Mackinnon SE. Social impact of peripheral nerve injuries. Hand. 2015;10(2):161-7.
- He B, Zhu Z, Zhu Q, Zhou X, Zheng C, Li P, et al. Factors predicting sensory and motor recovery after the repair of upper limb peripheral nerve injuries. Neural regeneration research. 2014;9(6):661-72. Available from: http:// dx.doi.org/10.4103/1673-5374.130094.
- Naumova ES, Nikitin SS, Druzhinin DS. Kolichestvennye sonograficheskie kharakteristiki perifericheskikh nervov u zdorovykh lyudey [Quantitative sonographic characteristics of peripheral nerves in healthy people]. Annaly klinicheskoy i eksperimental’noy nevrologii. 2017;11(1):55-61
- Huckhagel T, Nüchtern J, Regelsberger J, Lefering R, Trauma Register DGU. Nerve injury in severe trauma with upper extremity involvement: evaluation of 49,382 patients from the Trauma Register between 2002 and 2015. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2018;26:76. Available from: http://dx.doi.org/10.1186/s13049-018-0546-6.
- Strafun SS, Borzikh NO, Gayko OG, Borzikh OV, Gayovich VV, Tsimbalyuk YAV. Prioritetnye napravleniya khirurgicheskogo lecheniya ranenykh s povrezhdeniyami perifericheskikh nervov verkhney konechnosti pri polistrukturnykh travmakh [Priority areas of surgical treatment of wounded with injuries of the peripheral nerves of the upper limb with polystructural injuries]. Travma. 2018;19(3):75-80. Available from: http://dx.doi. org/10.22141/1608-1706.3.19.2018.136410.
- Vishnevskiy VA. Nekotorye voprosy lecheniya travm perifericheskikh nervov konechnostey [Some issues in the treatment of peripheral nerve injuries of the limbs]. Scientific Journal «Science Rise». 2015;11(3):60-5. Available from: http://dx.doi.org/10.15587/2313-8416.2015.54279.
- Yi S, Zhang H, Gong L, Wu J, Zha G, Zhou S, et al. Deep sequencing and bioinformatic analysis of lesioned sciatic nerves after crush injury. PLoS One. 2015;10(12):e0143491.
- Moore AM, Wagner IJ, Fox IK. Principles of nerve repair in complex wounds of the upper extremity. Seminars in Plastic Surgery. 2015;29(1):40-7. Available from: http://dx.doi.org/10.1055/s-0035-1544169.
- Simon NG, Simon NG, Spinner RJ, Kline DG, Kliot M. Advances in the neurological and neurosurgical management of peripheral nerve trauma. J Neurol Neurosurg Psychiatry. 2016;87(2):198-208. Available from: http:// dx.doi.org/10.1136/jnnp-2014-310175.
- Isaacs J, Safa B. A preliminary assessment of the utility of largecaliber processed nerve allografts for the repair of upper extremity nerve injuries. Hand. 2017;12(1):55-9. Available from: http://dx.doi. org/10.1177/1558944716646782
- Novak CB, Rebecca L. Rehabilitation of the upper extremity following nerve and tendon reconstruction: when and how. Seminars in Plastic Surgery. 2015;29(1):73-80. Available from: http://dx.doi. org/10.1055/s-0035-1544172.
- Karim-zade GD, Malikov MKh, Ibragimov EK, Khayrulloi Narzillo, Mirzobekov KhF, Makhmadkulova NA. Korrektsiya myagkotkannykh defektov i posledstviy povrezhdeniya sosudisto-nervnykh puchkov verkhnikh konechnostey [Correction of soft-tissue defects and consequences of neurovascular bundles damage of the upper extremities]. Vestnik Avitsenny [Avicenna Bulletin]. 2018;20(4):395-401. Available from: http://dx.doi.org/10.25005/2074-0581- 2018-20-4-395-401
- Malikov MKh, Karim-zade GD, Davlatov AA, Ibragimov EK, Kamolov AN, Makhmadkulova NA, i dr. Rekonstruktivnaya khirurgiya sochetannykh povrezhdeniy verkhnikh konechnostey [Reconstructive surgery of combined injuries of the upper limbs]. Vestnik Avitsenny [Avicenna Bulletin]. 2018;20(4):410-415. Available from: http://dx.doi.org/10.25005/2074-0581- 2018-20-4-410-415.
Odinaev Mirali Fayzulloevich
, Researcher of the Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery ORCID ID: 0000-0002-5361-1724, Researcher ID: C-5172-2019
Khodzhamuradov Gafur Mukhammadmukhsinovich
, Doctor of Medical Sciences, Senior Researcher, Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery ORCID ID: 0000-0002-7095, Researcher ID: F-4112-2018
Shaymonov Aziz Khuseynovich
, Candidate of Medical Sciences, Researcher of the Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery ORCID ID: 0000-0002-9872-9718, Researcher ID: C-3843-2019
Saidov Makhmadullo Sayfulloevich
, Researcher, Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery ORCID ID: 0000-0001-9003-1609, Researcher ID: E-8505-2018
Conflict of interest: No conflict
Address for correspondence:
Saidov Makhmadullo Sayfulloevich
Researcher, Department of Reconstructive Surgery, Republican Scientific Center for Cardiovascular Surgery
734003, Republic of Tajikistan, Dushanbe, Sanoi str., 33
Tel.: +992 (918) 626332
Materials on the topic:
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- CLINICAL IMPORTANCE OF DIVIDING DISTAL COMPLETE NERVE DAMAGES OF THE UPPER EXTREMITY INTO TOPOGRAPHIC ZONES
- EXPERIENCE OF THE USE OF VARIOUS METHODS OF SURGICAL TREATMENT OF THE CHEILOSCHISIS AND PALATE
- OPTIMIZATION OF SURGICAL TREATMENT OF POST-BURNING TIGHTENING SCARS OF FRONT SURFACE OF THE NECK AND THE CHEST
- MODERN APPROACH TO THE DIAGNOSTIC AND SURGICAL TREATMENT OF THE NASAL SEPTUM CURVATURE
- SURGICAL TREATMENT OF POST-BURN SCARS OF NECK AND CHEST