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Research Article| Volume 11, ISSUE 2, P111-117, April 1998

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Peripheral nerve regeneration, repair, and grafting

  • Alexander Bee Dagum
    Correspondence
    Correspondence and reprint requests to Alexander Bee Dagum, MD, FRCS(C), 117 King Street E, Oshawa, Ontario, Canada L1H 1B9.
    Affiliations
    Oshawa General Hospital and St. Michael's Hospital, Toronto, Ontario, Canada
    Department of Surgery, Division of Plastic Surgery, University of Toronto
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      Abstract

      Peripheral nerve injuries are a major source of chronic disability. Advances in microsurgery and a better understanding of nerve healing have greatly improved the outcomes of nerve repair in the past two decades. This paper reviews the current thoughts on peripheral nerve regeneration and repair. Controversial topics such as the timing of nerve repair, new techniques of nerve repair (fibrin glue, lasers, and tubulization), nerve grafting, and the treatment of neuroma are discussed. A general approach to postoperative care is presented and shown to be governed by an understanding of not only nerve healing but tissue healing in general. A summary of current clinical results of upper extremity nerve repairs is given to provide benchmarks of practice for hand therapy units to achieve and supersede.
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      References

        • Woodall B
        • Beebe WG
        Peripheral Nerve Regeneration: A Follow-up Study of 3,656 World War II Injuries. Department of Veterans Affairs Medical Monograph. US Government Printing Office, Washington, DC1956
        • Dagum AB
        • Hurst LC
        • Badalamente MA
        Nerve injury: healing, repair and grafting.
        in: Dee R Hurst LC Principles of Orthopedic Practice. McGraw-Hill, New York1997: 1207-1214
        • Mackinnon SE
        • Dellon AL
        Surgery of the Peripheral Nerve. Thieme Medical Publishers, New York1988
        • Chow JA
        • Sunderland S
        • Van Beek AL
        Surgical significance of the motor fascicular group of the ulnar nerve in the forearm.
        J Hand Surg. 1985; 10A: 867-872
        • Chow JA
        • Van Beek AL
        • Bilos ZJ
        • et al.
        Anatomic basis for the repair of ulnar and median nerves in the distal part of the forearm by group fascicular suture and nerve grafting.
        J Bone Joint Surg. 1986; 68A: 273-280
        • Lundborg G
        Structure and function of the intraneural mi-crovessels as related to trauma, edema formation, and nerve function.
        J Bone Joint Surg. 1975; 57A: 938-948
        • Lundborg G
        • Dahlin L
        • Danielsen N
        • Zhao Q
        Trophism, tropism, and specificity in nerve regeneration.
        J Reconstr Microsurg. 1994; 10: 345-353
        • Seddon HJ
        Three types of nerve injury.
        Brain. 1943; 66: 237
        • Sunderland S
        A classification of peripheral nerve injuries producing loss of function.
        Brain. 1951; 74: 491
        • Brushart TM
        Motor axons preferentially reinnervate motor pathways.
        J Neurosci. 1993; 13: 2730-2738
        • Chaudhry V
        • Cornblath DR
        Wallerian degeneration in human nerves: serial electrophysiological studies.
        Muscle Nerve. 1992; 15: 687-693
        • Badalamente MA
        • Hurst LC
        • Paul SB
        • Stracher A
        Enhancement of neuromuscular recovery after nerve repair in primates.
        J Hand Surg. 1987; 12B: 211-217
        • Badalamente MA
        • Hurst LC
        • Stracher A
        Recovery after delayed nerve repair: influence of a pharmacologic adjunct in a primate model.
        J Reconstr Microsurg. 1992; 8: 391-397
        • Badalamente MA
        • Hurst LC
        • Stracher A
        Neuromuscular recovery after peripheral nerve repair: effects of an orally administered peptide in a primate model.
        J Reconstr Microsurg. 1995; 11: 429-437
        • Nemoto K
        • Williams HB
        • Nemoto K
        • Lough J
        • Chiu RC
        The effects of electrical stimulation on denervated muscle using implantable electrodes.
        J Reconstr Microsurg. 1988; 4: 251-257
        • Leffert RD
        Brachial Plexus Injuries. Churchill Livingstone, New York1985
        • Jabaley ME
        • Wallace WH
        • Hechler FR
        Internal topography of major nerves of the forearm and hand: a current review.
        J Hand Surg. 1980; 5A: 1-18
        • Sunderland S
        Nerves and Nerve Injuries. 2nd ed. Churchill Livingstone, New York1978
        • Terris DJ
        • Fee Jr, WE
        Current issues in nerve repair.
        Arch Otolaryngol Head Neck Surg. 1993; 119: 725-731
        • Mackinnon SE
        Peripheral nerve injuries.
        in: Manske PR Hand Surgery Update. American Society for Surgery of the Hand, Colorado1994: 221-311
        • Dellon AL
        Wound healing in nerve.
        Clin Plast Surg. 1990; 17: 545-570
        • Young L
        • Wray RC
        • Weeks PM
        A randomized prospective comparison of fascicular and epineural digital nerve repairs.
        Plast Reconstr Surg. 1981; 68: 89-92
        • Mailander P
        • Berger A
        • Schaller E
        • Ruhe K
        Results of primary nerve repair in the upper extremity.
        Microsurgery. 1989; 10: 147-150
        • Novak CB
        • Kelly L
        • Mackinnon SE
        Sensory recovery after median nerve grafting.
        J Hand Surg. 1992; 17A(1): 59-68
        • Badalamente MA
        • Hurst LC
        • Ellstein JE
        • McDevitt CA
        The pathobiology of human neuromas: an electron microscopic and biomechanical study.
        J Hand Surg. 1985; 10B(l): 49-53
        • Nath RK
        • Mackinnon SE
        Management of neuromas in the hand.
        Hand Clin. 1996; 12: 745-756
        • Williams HB
        The painful stump neuroma and its treatment.
        Clin Plast Surg. 1984; 11: 79-84
        • Mackinnon SE
        • Glickman LT
        • Dagum AB
        A technique for the treatment of neuroma-in-continuity.
        J Reconstr Microsurg. 1992; 8: 379-383