IP International Journal of Aesthetic and Health Rejuvenation

My study on microsurgical repair of injured peripheral nerves in 1990s

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Article Type : Original Article

Author Details: Sudhir Singh*

Volume : 3

Issue : 1

Online ISSN : XXXX

Print ISSN : XXXX

Article First Page : 22

Article End Page : 28

Abstract

Aim: The aim of this study is to evaluate the result of microsurgical repair over non microsurgical treatment of injured peripheral nerves. We also tried to see the efficiency of venous cuffe applied over epineural repair of nerves. The role and feasibility of use of venous conduit of more than 8 cm length to manage extensive nerve gap was tried.
Materials and Methods: a). Sample Design: Thirty cases of microsurgical repair of peripheral nerve injuries were selected during late mid1992 to mid1994 and it formed Group B of study. Group A consisted of double number of patients that is sixty who had undergone non microsurgical repair of peripheral nerve injuries in past between 1985 to early mid1992. Microsurgical results of Group B patients were compared with non microsurgical results of Group A patients. b). Tools & Techniques: Whenever possible preoperative electro diagnostic studies like NCV done to form baseline study, then followed by postoperative NCV also in most cases. The accurate recording of data, investigations, and evaluation of the results of repair were done.
Observation: Incidence is increasing with age due to increase in life span and more males are involved as they are more exposed to hazardous life. Even business community and students are being affected but earlier the farmers were more commonly affected. Urban cases have risen now and almost equating with earlier rural incidence. Other modes of injury have also become more common than past incidence of pure cut injury. More of microsurgical neurolysis and decompression of nerves were done in comparision to more of non microsurgical epineural nerve repair required earlier due to difference in nature of injury which came to us. It was due to many cases of nerve traction and compression injuries in microsurgical treatment patients. First time use of venous tube to bridge the nerve gap of 8cm was tried by us but clinical result even after long duration was not good. However the strands of nerve growth fibres could be detected under high microscope after slicing the venous tube to see inside when tendon transfer was planned for the patient. The neuro venous biopsy from proximal part was seen to have nerve growth in it.
Conclusion: All patients who underwent microsurgical treatment had better recovery. Median, radial and ulnar nerves are involved more than other nerves. Ulnar nerve treated by microsurgical treatment had sensory recovery almost at par with median nerve. Venous cuffe were found to be beneficial which prevented abnormal axonerration but however long vein tube was not good inspite of nerve growth inside the proximal part of nerve seen after biopsy which was done when tendon transfer was planned as ultimate care of the patient.
Future Aspect:  Future of peripheral nerve repair will lie in accurate rotational placement perhaps using tissue glue and neurotrophic agents and the work in this field will be interesting in relation to the work which has been done on neurotrophism in free lying nerve ends.

Keywords: Nerves repair, Veinous tube, Nerve regeneration, Microsurgical repair, Neurolysis, Venous cuffe.

Doi No:-10.18231