Khater, A., Younis, R., El Sayed, N. (2020). Excision and Inter-Positional Sural Nerve Graft for Post-Traumatic Non-Conducting Ulnar Nerve Neuroma. The Egyptian Journal of Plastic and Reconstructive Surgery, 44(3), 401-406. doi: 10.21608/ejprs.2020.122293
Amr Mohamed Khater; Reda Abdallah Younis; Nehal Tharwat Mohamed El Sayed. "Excision and Inter-Positional Sural Nerve Graft for Post-Traumatic Non-Conducting Ulnar Nerve Neuroma". The Egyptian Journal of Plastic and Reconstructive Surgery, 44, 3, 2020, 401-406. doi: 10.21608/ejprs.2020.122293
Khater, A., Younis, R., El Sayed, N. (2020). 'Excision and Inter-Positional Sural Nerve Graft for Post-Traumatic Non-Conducting Ulnar Nerve Neuroma', The Egyptian Journal of Plastic and Reconstructive Surgery, 44(3), pp. 401-406. doi: 10.21608/ejprs.2020.122293
Khater, A., Younis, R., El Sayed, N. Excision and Inter-Positional Sural Nerve Graft for Post-Traumatic Non-Conducting Ulnar Nerve Neuroma. The Egyptian Journal of Plastic and Reconstructive Surgery, 2020; 44(3): 401-406. doi: 10.21608/ejprs.2020.122293
Excision and Inter-Positional Sural Nerve Graft for Post-Traumatic Non-Conducting Ulnar Nerve Neuroma
1The Department of Plastic Surgery, Faculty of Medicine, Mansoura University
2The Department of Radiodiagnosis, Faculty of Medicine, Mansoura University
Abstract
Introduction: Ulnar nerve injuries around the wrist result in paralysis of intrinsic muscles and sensory loss of little finger and ulnar half of ring finger. Formation of traumatic neuroma of the ulnar nerve adds pain at the site of nerve repairs. Patients and Methods: 10 patients were included in this study. Clinical, radiological and electrophysiological assessment indicate surgery in these patients where neuroma was excised, identification of sensory and motor fascicles of the ulnar nerve was done and cable nerve grafts were used to bridge the nerve defects. Assessment of the outcome was done in patients who finished follow-up for at least one year. Results: Pain at the site of neuroma disappeared after surgery. All patients were followed-up and 6 patients needed tendon transfer after one year. Sensory recovery was achieved after one year. Trophic changes and cold intolerance was improved. Discussion: Primary repair of ulnar nerve injuries is the gold standard treatment for such injuries. Claw hand, weakness of the hand grip and abduction deformities are the main motor defects which can be corrected by tendon transfers. However, sensory defects and cold intolerance affected the outcome of surgery. When the diagnosis of non-conducting neuroma is made, neuroma resection and reconstruction improve the clinical outcome. Conclusion: The unfavorable outcomes of ulnar nerve injuries can be improved by resection of neuroma in continuity and nerve grafting. Multidisciplinary team is needed to achieve the best clinical outcomes.
1- Sunderland S.: The anatomy and physiology of nerve injury. Muscle Nerve, 13: 771-784, 1990. 2- Mackinnon S.E. and Dellon A.L.: Results of treatment of recurrent dorsoradial wrist neuromas. Ann. Plast. Surg., 19 (1): 54-61, 1987. 3- Mackinnon S.E., Dellon A.L., Hudson A.R. and Hunter D.A.: Alteration of neuroma formation by manipulation of its microenvironment. Plast. Reconstr. Surg., 76: 345- 352, 1985. 4- Yüksel F., Kis¸laogˇlu E., Durak N., Uçar C. and Karacaog ˇlu E.: Prevention of painful neuromas by epineural ligatures, flaps and grafts. Br. J. Plast. Surg., 50: 182- 185, 1997. 5- Sapienza A. and Green S.: Correction of the Claw Hand. Hand Clin., 28: 53-66, 2012. 6- Kouyoumdjian J.A.: Peripheral nerve injuries: A retrospective survey of 456 cases. Muscle Nerve, 34: 785, 2006. 7- Vordemvenne T., Langer M., Ochman S., et al.: Longterm results after primary microsurgical repair of ulnar and median nerve injuries: A comparison of common score systems. Clin. Neurol. Neurosurg., 109: 263, 2007. 8- Allan C.H. and Vanderhooft E.: Functional outcomes after nerve grafting. Atlas Hand Clin., 10: 93, 2005. 9- Kim D.H., Han K., Tiel R.L., Murovic J.A. and Kline D.G.: Surgical outcomes of 654 ulnar nerve lesions. J. Neurosurg., 98: 993, 2003. 10- Andreisek G., Crook D.W., Burg D., Marincek B. and Weishaupt D.: Peripheral neuropathies of the median, radial and ulnar nerves: MR imaging features. Radiographics, 26: 1267-1287, 2006. 11- Cobb T.K., Carmichael S.W. and Cooney W.P.: Guyon’s canal revisited: An anatomic study of the carpal ulnar neurovascular space. J. Hand Surg., 9: 861-869, 1996. 12- Sunderland S., Marshall R.D. and Swaney W.E.: The intraneural topography of the circumflex, musculocutaneous and obturator nerves. Brain, 32: 116-29, 1959. 13- Sunderland S.: The intraneural topography of the radial, median and ulnar nerves. Brain, 68: 243-98, 1945. 14- Williams H.B. and Jabaley M.E.: The importance of internal anatomy of the peripheral nerves to nerve repair in the forearm and hand. Hand Clin., 2: 689-707, 1986. 406 Vol. 44, No. 3 / Excision & Inter-Positional Sural Nerve Graft 15- Chow J.A., Van Beek A.L., Meyer D.L. and Johnson M.C.: Surgical significance of the motor fascicular group of the ulnar nerve in the forearm. J. Hand Surg. Am., 10: 867- 72, 1985. 16- Brandt K.E. and Mackinnon S.E.: Microsurgical repair of peripheral nerves and nerve grafts. In: Aston S.J., Beasley R.W., Throne C.H.M., editors. Grabb and Smith’s Plastic Surgery, 5th edition. Philadelphia: Lippincott Williams & Wilkins, 1997. 17- Wang Y., Sunitha M., Kevin C. and Chung K.C.: How to Measure Outcomes of Peripheral Nerve Surgery. Hand Clin., 29 (3): 349-361. 18- Bergmeister K.D., Große-Hartlage L., Daeschler S.C., Rhodius P., Böcker A., Beyersdorff M., Kern A.O., Kneser U. and Harhaus L.: Acute and long-term costs of 268 peripheral nerve injuries in the upper extremity. PLoS One, 6; 15 (4): e0229530, 2020. 19- Sunderland S.: Ulnar nerve lesions. In Nerves and Nerve Injuries. Edinburgh: Churchill Livingstone, 750-779, 1978. 20- Dellon A.L., Curtis R.M. and Edgerton M.T.: Reeducation of sensation in the hand after injury and repair. Plast. Reconstr. Surg., 53: 297, 1974. 21- Vikström P., Björkman A., Carlsson I.K., Olsson A.K. and Rosén B.: Atypical sensory processing pattern following median or ulnar nerve injury - a case-control study. BMC Neurol., Sep. 19; 18 (1): 146, 2018. 22- Watson J., Gonzalez M., Romero A. and Kerns J.: Neuromas of the Hand and Upper Extremity. J. Hand Surg., 35A: 499-510, 2010. 23- Carlsson I., Cederlund R., Hoglund P., Lundborg G. and Rosen B.: Hand injuries and cold sensitivity: Reliability and validity of cold sensitivity uestionnaires. Disability and rehabilitation, 30: 1920-8, 2008. 24- Elliot D., Lloyd M., Hazari A., et al.: Relief of the pain of neuromas-in-continuity and scarred median and ulnar nerves in the distal forearm and wrist by neurolysis, wrapping in vascularized forearm fascial flaps and adjunctive procedures. J. Hand Surg. Eur., 35: 575-82, 2010. 25- Jones N.F., Shaw W.W., Katz R.G., et al.: Circumferential wrapping of a flap around a scarred peripheral nerve for salvage of end-stage traction neuritis. J. Hand Surg. Am., 22: 527-35, 1997. 26- Ghoraba S.M., Mahmoud W.H., Elsergany M.A. and Ayad H.M.: Ulnar Nerve Injuries (Sunderland Grade V): A Simplified Classification System and Treatment Algorithm. Plast. Reconstr. Surg. Glob Open, 21; 7 (11): e2474, 2019. 27- Barrios C., Amillo S., Pablos J. and Canadell J.: Secondary repair of ulnar nerve injury: 44 cases followed for 2 years. Acta. Orthop. Scand, 61: 46, 1990. 28- Terzis J.K. and Kokkalis Z.T.: Outcomes of Secondary Reconstruction of Ulnar Nerve Lesions: Our Experience. Plast. Reconstr. Surg., 122: 1100, 2008. 29- Ding W., Li X., Pan J., Zhang P., Yin S., Zhou X., Li J., Wang L., Wang X. and Dong J.: Repair Method for Complete High Ulnar Nerve Injury Based on Nerve Magnified Regeneration. Ther. Clin. Risk Manag., Mar. 3 (16): 155- 168, 2020.
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