Abstract
The development of microsurgical techniques has changed the surgical treatment of severe hand injuries over the last 25 years. Not only has the repair of vessels by microvascular surgery brought new possibilities of treatment, but the results in repair or peripheral nerves have been improved by the use of new microsurgical techniques, such as perineural suture and interfascicular nerve grafts. The use of vascularized nerve grafts in multiple digit amputations has been a further new idea in emergency hand surgery. The operative treatment of lesions of the brachial plexus has become possible. Nevertheless, the traditional secondary operations such as tendon and muscle transfers are necessary in order to reach an optimal functional reconstruction following nerve injuries.
Résumé
Le dévelopement des techniques microchirurgicales a transformé le traitement des lésions graves de la main ces 25 dernières années. Non seulement la réparation de vaisseaux par les techniques microvasculaires apportait de nouvelles possibilitées de traitement mais aussi les résultats de réparation nerveuse étaient améliorés par les techniques microchirurgicales telles que la suture périneurale et la greffe nerveuse interfasiculaire. L'utilisation des greffons nerveux vascularisés dans les amputations digitales multiples est une nouvelle idée dans la chirurgie de la main. Le traitement des lésions du plexus brachial est une réalité de nos jours. Néanmoins, des interventions sécondaires classiques telles les tranferts de tendons ou de muscle sont souvent nécessaires pour obtenir un résultat fonctionnel optimal après la reconstruction nerveuse.
Resumen
El desarrollo de las técnicas microquirúrgicas ha modificado et tratamiento de las lesiones graves de la mano en los últimos 25 años. La reparatión de los vasos mediante cirugía microvascular ha traido nuevas posibilidades de tratamiento, pero los resultados de la reparación de los nervios periféricos han sido mejorados por el uso de nuevas técnicas microquirúrgicas, tales como la sutura perineural y los injertos interfasciculares de nervio. Un nuevo desarrollo en la cirugía de urgencia de la mano es el uso de los injertos vascularizados de nervio en casos de múltiples amputaciones de dedos. El tratamiento operatorio de las lesiones del Plejo Braquial se hizo factible. Sin embargo, las tradicionales operaciones secundarias taies como las transferencias de tendón y de músculo son todavía necesarios para lograr una óptima reconstrucción funcional en las lesiones de los nervios.
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References
Seddon, H.J.: Three types of nerve injury. Brain66:237, 1943
Sunderland, S.: A classification of peripheral nerve injuries producing loss of function. Brain74:491, 1951
Weber, E.: Über den Tastsinn. Arch. Anat. Physiol.1:152, 1835
Dellon, A.L.: The moving two-point discrimination test: Clinical evaluation of the quickly-adapting fiber/receptor system. J. Hand Surg.3:474, 1978
Millesi, H., Berger, A., Meissl, G.: Experimentelle Untersuchungen zur heilung durchtrennter peripherer nerven. Chir. Plast.1:174, 1972
Taylor, G.I., Ham, F.J.: The free vascularized nerve graft. Plast. Reconstr. Surg.57:413, 1976
Sugioka, H., Tsuyama, N., Hara, T., Negana, A., Tachibana, S., Ochiai, N.: Investigation of brachial plexus injuries via intraoperative cortical somatosensory evoked potentials. Arch. Orthop. Trauma. Surg.99:143, 1982
Berger, A., Mailänder, P., Ingianni, G., Narakas, A., Millesi, H.: Integrierte konzepte in der therapie der plexus brachialis-läsionen. Langenbecks Arch. Chir.375:125, 1990
Millesi, H.: Surgical management of brachial plexus injuries. J. Hand Surg.2:367, 1977
Berger, A.: Die primäre Versorgung von nervenverletzungen. Arzt und Krankenhaus5:116, 1985
Mailänder, P., Berger, A., Schaller, E., Ruhe, K.: Results of primary nerve repair in the upper extremity. Microsurgery10:147, 1989
Berger, A., Mailänder, P., Schaller, E.: Free vascularized nerve grafts. In Peripheral Nerve Lesions, M. Samii, editor, New York, Springer, 1990, pp. 326–334
Breidenbach, W., Terzis, J.: The anatomy of free vascularized nerve grafts. Clin. Plast. Surg.11:65, 1984
Fachinelli, A., Masquelet, A., Restrepo, J., Gilbert, A.: The vascularized sural nerve graft. Int. J. Microsurg.3:57, 1981
Künzel, K.H., Fischer, C., Anderl, H.: The ulnar nerve as a vascularized nerve transplant. J. Reconstr. Microsurg.2:175, 1986
Highet, W.B., Sanders, F.K.: The effects of stretching nerves after suture. Br. J. Surg.30:355, 1943
Dellon, A.L.: Evaluation of sensibility and re-education of sensation in the hand, Baltimore, Williams and Wilkins, 1981
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Berger, A., Mailänder, P. Advances in peripheral nerve repair in emergency surgery of the hand. World J. Surg. 15, 493–500 (1991). https://doi.org/10.1007/BF01675646
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DOI: https://doi.org/10.1007/BF01675646