Harilaos Sakellarides, MD
Boston University School of Medicine- Department of Orthopedic/Hand Surgery; Boston, MA
PURPOSE OF STUDY
To demonstrate that autogenous nerve grafting can give rewarding results provided certain techniques can be provided.
There were 130 cases in all; 70 involved the median nerve, 40 the ulnar nerve, and 20 the radial nerve; 85 males and 45 females. Ages ranged fiom 20 to 60 years. The time of the injury to grafting was fiom six months to five years. Follow-up ranged fiom two to fifteen years. The procedure consists of exploring the injured peripheral nerve with excision of neuromas and insertion of autogenous nerve grafts that were taken fiom the lower extremities of the patient. The nerve grafts were approximated to the proximal and distal ends of the injured nerve under the microscope by using fine instruments and microsurgical techniques.
SUMMARY OF RESULTS:
Motor recovery for median nerve low lesions namely recovery of thenar muscles fiom M3-M4 level- Excellent in 40%; M2-M3 ~ood-in40 %; Ml-M2 Fair in 20%. Ulnar nerve motor recovery for intrinsics to level M3-M4-Excellent in 38%. For level M2-M3-Good 40%; M.1-M2-Fair 22%. Motor recovery for radial nerve: extensors of wrist, fingers and thumb, to level M3-M4-Excellent in 42%; Good 37%; Fair 20%.
In a large number of patients, this method has improved the function of the extremity considerably. It has given us much superior results than before the use of microscope and microsurgical instruments. By doing nerve grafting, one avoids excessive mobilization of nerve ends, stretching, suture under tension and immobilizing of joints.