Articles: peripheral-nerve-injuries.
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Review Historical Article
[Peripheral nerve repair: 30 centuries of scientific research].
Nerve injury compromises sensory and motor functions. Techniques of peripheral nerve repair are based on our knowledge regarding regeneration. Microsurgical techniques introduced in the late 1950s and widely developed for the past 20 years have improved repairs. However, functional recovery following a peripheral mixed nerve injury is still incomplete. ⋯ This review presents the recent advances in understanding of neural regeneration and their application to the management of primary repairs and nerve gaps.
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J Hand Surg Eur Vol · Jun 2005
Review Meta AnalysisAssessment of sensibility after nerve injury and repair: a systematic review of evidence for validity, reliability and responsiveness of tests.
Recovery of sensibility after peripheral nerve injury and repair needs to be assessed using psychometrically robust measures. In this study the literature was reviewed to identify what tests are available to quantify sensibility and to assess their validity, reliability and responsiveness. ⋯ While there is a plethora of tests and studies reporting the outcomes after peripheral nerve suture only a few of the tests have evidence of validity, reliability and responsiveness. Currently the touch threshold test using monofilaments such as the Weinstein Enhanced Sensory Test (WEST) or Semmes-Weinstein Monofilament Test (SWMT) and the shape-texture identification (STI) test for tactile gnosis are the only tests which meet criteria for a standardized test and have had their psychometric properties evaluated and quantified.
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Intraoperative positioning nerve injuries are regrettable complications of surgery thought to arise from stretch and/or compression of vulnerable peripheral nerves. Generally thought to be preventable, these injuries still occur in patients despite rigorous preventative measures. ⋯ Prevention remains the mainstay of the management of positioning injuries. Diagnosed and managed appropriately, these lesions typically improve completely over time.
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The management of peripheral nerve injury continues to be a major clinical challenge. The most widely used technique for bridging defects in peripheral nerves is the use of autologous nerve grafts. This technique, however, necessitates a donor nerve and corresponding deficit. ⋯ The main disadvantages of this technique are the risk that nerve fibers can grow out of the muscle tissue during nerve regeneration, and that a donor site is necessary to harvest the muscle tissue. Despite publications on nerve conduits as an alternative for peripheral nerve repair, autologous nerve grafting is still the standard care for treatment of a nerve gap in the clinical situation; however, the use of the skeletal muscle tissue technique can be added to the surgeon's arsenal of peripheral nerve repair tools, especially for bridging short nerve defects or when traditional nerve autografts cannot be employed. This technique has been investigated both experimentally and clinically and, in this article, an overview of the literature on skeletal muscle grafts for bridging peripheral nerve defects is presented.