Microsurgery
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Traumatic brachial plexus injuries in children, excluding birth palsy, are seldom reported. In this study, we report on 11 cases operated upon between 1995-1998, and followed for at least 30 months. All patients were males with an average age of 11 years (range, 3-16 years). ⋯ Harvesting the phrenic nerve and the contralateral C7 root resulted in no residual morbidity. Compared to adults, children have a higher incidence of root avulsion, no deafferentiation pain, a higher incidence of associated skeletal injuries, and the same recovery rate of elbow and shoulder functions following plexus reconstruction, but recovery is faster. Given the frequency of root avulsions, neurotization is often required.
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Surgical training is undergoing a rapid transformation, which has been influenced by advances in computer modeling. Increased pressure to reduce the use of animals in technical training has led to a new approach in teaching microsurgery. ⋯ In doing so, we review articles from the latest journals and authenticated Internet websites to compare and contrast these various methods. Finally, we look at the specific technique that has potential impact on the future modeling of microsurgical techniques.
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Comparative Study
Comparison of functional results of nerve graft, vein graft, and vein filled with muscle graft in end-to-side neurorrhaphy.
End-to-side neurorrhaphy is an alternative method in the situation where the proximal part of the nerve cannot be found. When the intact nerve is not close enough to perform end-to-side neurorrhaphy, it will be necessary to use a graft for transporting the regenerating axons. In this study, we tried to find out whether it is possible to use a graft in an end-to-side neurorrhaphy, and compared the nerve graft with possible alternative grafts, i.e., vein and muscle-filled vein grafts. ⋯ Based on walking-track analysis and fiber diameters, the differences of all three groups were statistically significant (P < 0.05). While the differences of myelinated fibers between the first and second groups were not significant, the differences between the rest (group 1-group 3 and group 2-group 3) were significant (P < 0.05). Our study showed that, in end-to-side neurorrhaphy, the use of a nerve graft is possible, and a vein graft is also a good alternative, but a muscle-filled vein graft is not.
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The purpose of this experimental study was to investigate the effects of topical applications of hyaluronic acid on peripheral nerve scarring and regeneration in an adult rat model. After the right sciatic nerves of 48 rats were transected and immediately repaired, nerves were randomly divided into two groups. Nerves to which were applied hyaluronic acid comprised the experimental group, and nerves to which were applied saline comprised the control group. ⋯ Histomorphologic nerve analysis, electrophysiologic studies, muscle mass evaluation, and serial functional walking-track analysis were performed for evaluation of peripheral nerve regeneration at 12 weeks. The results showed better conduction velocities, increased axon-fiber diameter, and faster functional recovery in hyaluronic acid-treated nerves (P < 0.05, Student's t-test). In conclusion, hyaluronic acid appears to be effective in preventing perineural scar formation, resulting in enhancement of peripheral nerve regeneration.
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We applied a nerve transfer, using the ipsilateral C7 nerve root to treat the C5 and C6 root avulsion of the brachial plexus. Four patients with C5 and C6 preganglionic injury were operated on with this new technique from 1998-2000. Transfer of the spinal accessory nerve to the suprascapular nerve was simultaneously done in 2 these patients. ⋯ No remarkable impairment was found in all C7-innervated muscles except for decrease of muscle power of 1 grade (Lovett) in the short run. This new technique shows promise as an efficacious and safe treatment for C5 and C6 root avulsion of the brachial plexus. However, it should be applied prudently when incomplete injuries of the lower trunk are involved.