Repair of peripheral nerve with vein wrapping

Abstract

Objective: The post-traumatic neuro-anastomosis must be protected from the surrounding environment. This barrier must be biologically inert, biodegradable, not compressing but protecting the nerve. Formation of painful neuroma is one of the major issues with neuroanastomosis; currently there is no consensus on post-repair neuroma prevention. Aim of this study is to evaluate the efficacy of neuroanastomosis performed with venous sheath to reduce painful neuromas formation, improve the electrical conductivity of the repaired nerve, and reduce the discrepancies of the sectioned nerve stumps.

Patients and methods: From a trauma population of 320 patients treated in a single centre between January 2008 and December 2011, twenty-six patients were identified as having an injury to at least one of the peripheral nerves of the arm and enrolled in the study. Patients were divided into two groups. In the group A (16 patients) the end-to-end nerve suture was wrapped in a vein sheath and compared with the group B (10 patients) in which a simple end-to-end neurorrhaphy was performed. The venous segment used to cover the nerve micro-suture was harvested from the superficial veins of the forearm. The parameters analyzed were: functional recovery of motor nerves, sensitivity and pain. RESULTS. Average follow-up was 14 months (range: 12-24 months). The group A showed a more rapid motor and sensory recovery and a reduction of the painful symptoms compared to the control group (B).

Conclusions: The Authors demonstrated that, in their experience, the venous sheath provides a valid solution to avoid the dispersion of the nerve fibres, to prevent adherent scars and painful neuromas formation. Moreover it can compensate the different size of two nerve stumps, allowing, thereby, a more rapid functional and sensitive recovery without expensive devices.

Fig. 1 a, b, c, d

a) Dissection of the proximal and distal stump of peripheral nerve injured; b) the proximal nerve stumps is passed through the venous segment; c) end-to-end nerve suture performed; d) nerve suture covered by the venous sheath.

Fig. 2 a, b, c, d

a) Distal forearm laceration with radial nerve injury close to the nerve bifurcation; b) the two nerve stumps pass through the venous sheath, harvested at the level of a vein bifurcation; c) double end-to-end nerve suture; d) wrapping nerve suture “trousers-like”.

Fig. 3 a, b

a–b) Functional recovery at 12 months in forearm glass injury with section of the motor branch of Radial nerve. Intraoperative figures are shown in figure 1.

Fig. 4

Results after 12 months.