Defects of Nerve Trunks of Extremities and Modern Approach to Their Surgery

Yu.I. Boroda, V.P. Bersnev, N.P. Ryabukha, V.N. Musikhin

(Faculty of Neurosurgery, Saint Petersburg Medical Academy of Postgraduate Education
Hospital of the Leningradskaya Region)

The last quarter of the century was characterized by considerable advancement of nerve surgery due to development of electrophysiology and microsurgery. At the same time today there are many unsolved problems of treatment of nerve injuries. One of them is a choice of an optimum method of reconstructing injured nerve trunks of extremities. The present research was to find such a method.

Multimodality examination was carried out in 415 cases with injured nerves of extremities. There was a considerable defect of nervous tissue (5 cm and more) in 66.5% of them. The study allowed to elaborate an objective method for determining a degree of intention in a zone of a nerve suture and to substantiate optimum tactics of restoring continuity of a nerve trunk.

A degree of mobilization of nerve ends was determined by expressing a length of an exposed area of a nerve trunk in relative units, divisible by this nerve diameter. Such a method made it possible to compare a length of mobilization of different nerve trunks. Biomechanic peculiarities of conventional ways of bringing nerve ends together at different levels of their injury and intention dynamics on a suture line after eliminating an extremity abnormal position were demonstrated. We found two groups of anatomic zones of nerve injuries, which were important for prognosticating outcomes of operations on nerve trunks of extremities.

The authors were the first to substantiate a thesis, according to which a choice of an optimum type of reconstructive intervention, aimed at restoration of nerve trunk continuity, should be based not only on a defect size, but also on estimation of such factors as injury localization, a method of bringing nerve ends together and an intention degree in a suture zone.

The authors invented and introduce into practice new ways of suturing nerve ends and autoplasty of nerve trunk defects, a method of obtaining transplants for autoplasty, a method of treatment of extensive injuries of the radial nerve at a shoulder level, operative methods for restoration of foot sensitivity.

Experimental and anatomic studies demonstrated new technical aspects of autoplasty, which allowed to increase efficacy of this type of intervention.

Performing some versions of operations, aimed at neurotization via an autograft, was proved to be expedient in brachial plexux trauma.

The proposed system of surgical treatment of peripheral nerves permitted to achieve considerable improvement of its results in this category of patients.