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End-to-side nerve suture in traumatic injuries of brachial plexus: review of the literature and personal case seriesFrom UOD Reconstructive Microsurgery, Department of Orthopaedics and Traumatology, A.O. CTO-Maria Adelaide, Torino, Italy and Department of Orthopaedics, Traumatology, Rehabilitation, Plastic and Reconstructive Sciences, Second University of Naples, Italy Correspondence: Stefano Artiaco, Department of Orthopaedics and Traumatology, AO CTO-Maria Adelaide, Turin, Italy. E-mail:stefartiaco{at}libero.it. We used end-to-side nerve coaptation combined with standard end-to-end neurotisations to treat 11 patients who presented with complete (six cases) or incomplete (five cases) traumatic brachial plexus injuries. All patients were available for functional evaluation at a minimum of 2 years postoperatively. In three patients with shoulder abduction recovery, electromyographical studies (EMG) showed a contribution from the end-to-side neurotisation. In the remaining cases end-to-side neurotisations were unsuccessful. Our study did not demonstrate a reliable role for end-to-side nerve suture in brachial plexus surgery. We believe that at present end-to-side suture must not be a substitute for standard reconstructive techniques in brachial plexus surgery. Occasionally termino-lateral nerve sutures may represent a support to standard reconstructive procedures especially in case of severe injuries when few undamaged donor nerves are available.
Key Words: end-to-side • neurorraphy • brachial plexus injury
This version was published on October
1, 2009 Journal of Hand Surgery (European Volume), Vol. 34, No. 5,
656-659 (2009) |
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