LONG-TERM RESULTS OF DELAYED REPAIR OF MEDIAN NERVE INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YINHonglei ¹ ,  YIChuanjun ² , ZHUYin ² , TIANGuanglei ²

1. Department of Orthopedics, Yixian County Hospital, Yi County Hebei, 074200, P. R. China;
2. Department of Hand Surgery, Beijing Jishuitan Hospital. Yi County Hebei, 074200, P. R. China;

Corresponding author：

YIChuanjun, Email: yicj@sina.com

Keywords：

Median nerve injury; Delayed repair; Long-term results; Nerve graft; Nerve release

DOI：

10.7507/1002-1892.20150212

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Objective To review and analyze the long-term results of delayed repair of median nerve injury. Methods Between January 2004 and December 2008, 228 patients with median nerve injury undergoing delayed repair were followed up for more than 4 years, and the clinical data were retrospectively analyzed. There were 176 males (77.19%) and 52 females (22.81%), aged 2-71 years (median, 29 years). The main injury reason was cutting injury in 159 cases (69.74%);203 cases had open injury (89.04%). According to the injury level, injury located at area I (upper arm) in 38 cases (16.67%), at area II (elbow and proximal forearm) in 53 cases (23.25%), at area III (anterior interosseous nerve) in 13 cases (5.70%), and at area IV (distal forearm to wrist) in 124 cases (54.39%). The delayed operations included delayed suture (50 cases, 21.93%), nerve release (149 cases, 65.35%), and nerve graft (29 cases, 12.72%). Results For patients with injury at area I and area II, the results were good in 23 cases (25.27%), fair in 56 cases (61.54%), and poor in 12 cases (13.18%) according to modified Birch and Raji’s median nerve grading system;there was significant difference in the results between 3 repair methods for injury at area II (χ²=6.228, P=0.044), but no significant difference was found for injury at area I (χ²=2.241, P=0.326). Twelve patients (13.18%) needed musculus flexor functional reconstruction. Recovery of thenar muscle was poor in all patients, but only 5 cases (5.49%) received reconstruction. Thirteen cases of nerve injury at area III had good results, regardless of the repair methods. For patients with injury at area IV, the results were excellent in 6 cases (4.84%), good in 22 cases (17.74%), fair in 72 cases (58.06%), and poor in 24 cases (19.35%) according to Birch and Raji’s grading system;there was significant difference in the results between 3 repair methods (χ²=12.646, P=0.002), and the result of delayed repair was better. Conclusion The results of delayed repair is poor for all median nerve injuries, especially for high level injury. The technique of repair methods vary with injury level. For some delayed median nerve injuries, early nerve transfer may be a better choice for indicative patients.

Citation： YINHonglei, YIChuanjun, ZHUYin, TIANGuanglei. LONG-TERM RESULTS OF DELAYED REPAIR OF MEDIAN NERVE INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(8): 986-991. doi: 10.7507/1002-1892.20150212 Copy

1.	Birch R,Raji A.Repair of median and ulnar nerves.Primary suture is vest.J Bone Joint Surg (Br),1991,73(1):154-157.
2.	Birch R,Bonney G,Wynn Parry CB.Clinic aspects of nerve injury//Birch R,Bonney G,Wynn Parry CB.Surgical disorders of the peripheral nerves.London:Churchill Livingstone,1998:71-87.
3.	Novak CB,Mackinnon SE.Evaluation of nerve injury and nerve compression in the upper quadrant.J Hand Ther,2005,18(2):230-240.
4.	Rolfe Birch.Nerve repair//Wolfe SW,Hotchkiss RN,Pederson WC.3rd eds.Green's operative hand surgery.Philadelphia:Churchill Livingstone,2011:1057-1059.
5.	李文庆,王利,宫云霞,等.外伤性前臂正中神经损伤的治疗.中华手外科杂志,2005,21(1):40-41.
6.	Ruijs AC,Jaquet JB,Kalmijn S,et al.Median and ulnar nerve injuries:a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair.Plast Reconstr Surg,2005,116(2):484-496.
7.	Mailänder P,Berger A,Schaller E,et al.Results of primary nerve repair in the upper extremity.Microsurgery,1989,10(2):147-150.
8.	Jaquet JB,Luijsterburg AJ,Kalmijn S,et al.Median,ulnar,and combined median-ulnar nerve injuries:functional outcome and return to productivity.J Trauma,2001,51(4):687-692.
9.	Jaquet JB,Kalmijn S,Kuypers PD,et al.Early psychological stress after forearm nerve injuries:a predictor for long-term functional outcome and return to productivity.Ann Plast Surg,2002,49(1):82-90.
10.	Rosenfield J,Paksima N.Peripheral nerve injuries and repair in the upper extremity.Bull Hosp Jt Dis,2001-2002,60(3-4):155-161.
11.	Millesi H.Technique for nerve grafting.Hand Clin,2000,16(1):73-91.
12.	Gunther SF,DiPasquale D,Martin R.The internal anatomy of the meidian nerve in the region of the elbow.J Hand Surg (Am),1992,17(4):648-656.
13.	Tung TH,Mackinnon SE.Nerve transfer:indications,techniques,and outcomes.J Hand Surg (Am),2010,35(2):332-341.
14.	Mohseni MA,Pour JS,Pour JG.Primary and delayed repair and nerve grafting for treatment of cut median and ulnar nerves.Pak J Biol Sci,2010,13(6):287-292.
15.	de Medinaceli L,Prayon M,Merle M.Percentage of nerve injuries in which primary repair can be achieved by end-to-end approximation:Review of 2181 nerve lesions.Microsurgery,1993,14(4):244-246.
16.	McAllister RM,Gilert SE,Calder JS,et al.The epidemiology and management of upper limb peripheral nerve injuries in modern practice.J Hand Surg (Br),1996,21(1):4-13.
17.	Brown JM,Mackinnon SE.Nerve transfer in the forearm and hand.Hand Clin,2008,24(4):319-340.
18.	Bertelli JA,Ghizoni MF.Very distal sensory nerve transfers in high median nerve lesions.J Hand Surg (Am),2011,36(3):387-393.
19.	Jensen EG.Restoration of opposition of the thumb.Hand,1978,10(2):161-167.
20.	Foucher G,Molizos C,Sammut D,et al.Primary palmaris longus transfer as an oppomensplasty in carpal tunnel release:a series of 73 cases.J Hand Surg (Br),1991,16(1):56-60.
21.	Wang YR,Sunitha M,Chung KC.How to measure outcomes of peripheral nerve surgery.Hand Clin,2013,29(3):349-361.
22.	Rosén B,Lundborg G.A model instrument for the documentation of outcome after nerve repair.J Hand Surg (Am),2000,25(3):535-543.

1. Birch R,Raji A.Repair of median and ulnar nerves.Primary suture is vest.J Bone Joint Surg (Br),1991,73(1):154-157.
2. Birch R,Bonney G,Wynn Parry CB.Clinic aspects of nerve injury//Birch R,Bonney G,Wynn Parry CB.Surgical disorders of the peripheral nerves.London:Churchill Livingstone,1998:71-87.
3. Novak CB,Mackinnon SE.Evaluation of nerve injury and nerve compression in the upper quadrant.J Hand Ther,2005,18(2):230-240.
4. Rolfe Birch.Nerve repair//Wolfe SW,Hotchkiss RN,Pederson WC.3rd eds.Green's operative hand surgery.Philadelphia:Churchill Livingstone,2011:1057-1059.
5. 李文庆,王利,宫云霞,等.外伤性前臂正中神经损伤的治疗.中华手外科杂志,2005,21(1):40-41.
6. Ruijs AC,Jaquet JB,Kalmijn S,et al.Median and ulnar nerve injuries:a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair.Plast Reconstr Surg,2005,116(2):484-496.
7. Mailänder P,Berger A,Schaller E,et al.Results of primary nerve repair in the upper extremity.Microsurgery,1989,10(2):147-150.
8. Jaquet JB,Luijsterburg AJ,Kalmijn S,et al.Median,ulnar,and combined median-ulnar nerve injuries:functional outcome and return to productivity.J Trauma,2001,51(4):687-692.
9. Jaquet JB,Kalmijn S,Kuypers PD,et al.Early psychological stress after forearm nerve injuries:a predictor for long-term functional outcome and return to productivity.Ann Plast Surg,2002,49(1):82-90.
10. Rosenfield J,Paksima N.Peripheral nerve injuries and repair in the upper extremity.Bull Hosp Jt Dis,2001-2002,60(3-4):155-161.
11. Millesi H.Technique for nerve grafting.Hand Clin,2000,16(1):73-91.
12. Gunther SF,DiPasquale D,Martin R.The internal anatomy of the meidian nerve in the region of the elbow.J Hand Surg (Am),1992,17(4):648-656.
13. Tung TH,Mackinnon SE.Nerve transfer:indications,techniques,and outcomes.J Hand Surg (Am),2010,35(2):332-341.
14. Mohseni MA,Pour JS,Pour JG.Primary and delayed repair and nerve grafting for treatment of cut median and ulnar nerves.Pak J Biol Sci,2010,13(6):287-292.
15. de Medinaceli L,Prayon M,Merle M.Percentage of nerve injuries in which primary repair can be achieved by end-to-end approximation:Review of 2181 nerve lesions.Microsurgery,1993,14(4):244-246.
16. McAllister RM,Gilert SE,Calder JS,et al.The epidemiology and management of upper limb peripheral nerve injuries in modern practice.J Hand Surg (Br),1996,21(1):4-13.
17. Brown JM,Mackinnon SE.Nerve transfer in the forearm and hand.Hand Clin,2008,24(4):319-340.
18. Bertelli JA,Ghizoni MF.Very distal sensory nerve transfers in high median nerve lesions.J Hand Surg (Am),2011,36(3):387-393.
19. Jensen EG.Restoration of opposition of the thumb.Hand,1978,10(2):161-167.
20. Foucher G,Molizos C,Sammut D,et al.Primary palmaris longus transfer as an oppomensplasty in carpal tunnel release:a series of 73 cases.J Hand Surg (Br),1991,16(1):56-60.
21. Wang YR,Sunitha M,Chung KC.How to measure outcomes of peripheral nerve surgery.Hand Clin,2013,29(3):349-361.
22. Rosén B,Lundborg G.A model instrument for the documentation of outcome after nerve repair.J Hand Surg (Am),2000,25(3):535-543.

Chinese Journal of Reparative and Reconstructive Surgery

LONG-TERM RESULTS OF DELAYED REPAIR OF MEDIAN NERVE INJURY

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