(LML) Nerve transfers: an alternative technique along with tendon transfers, nerve repair, and nerve grafts

Leprosy Mailing List – July 8,  2019

Ref.: (LML)   Nerve transfers: an alternative technique along with tendon transfers, nerve repair, and nerve grafts.

From:  Wim Theuvenet, Apeldoorn, the Netherlands

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Dear Pieter,

Thank you for sharing these interesting articles! Are these techniques also applicable to the nerve problems that we see in leprosy?

In leprosy the nerves that are affected are more peripheral than at the spinal cord level as described in these publications

About ten years ago there were the first publications on more peripheral nerve transfers and nerve grafts.

For those interested in these options I would like to refer to the work of Susan Mackinnon and Lee Dellon, e.g. :

https://www.ncbi.nlm.nih.gov/pubmed/29605951

J Reconstr Microsurg. 2018 Nov;34(9):672-674. doi: 10.1055/s-0038-1639353. Epub 2018 Apr 1. Future Perspectives in the Management of Nerve Injuries by SE Mackinnon.

Abstract

AIM:

 The author presents a solicited "white paper" outlining her perspective on the role of nerve transfers in the management of nerve injuries.

METHODS:

 PubMed/MEDLINE and EMBASE databases were evaluated to compare nerve graft and nerve transfer. An evaluation of the scientific literature by review of index articles was also performed to compare the number of overall clinical publications of nerve repair, nerve graft, and nerve transfer. Finally, a survey regarding the prevalence of nerve transfer surgery was administrated to the World Society of Reconstructive Microsurgery (WSRM) results.

RESULTS:

 Both nerve graft and transfer can generate functional results and the relative success of graft versus transfer depended on the function to be restored and the specific transfers used. Beginning in the early 1990s, there has been a rapid increase from baseline of nerve transfer publications such that clinical nerve transfer publication now exceeds those of nerve repair or nerve graft. Sixty-two responses were received from WSRM membership. These surgeons reported their frequency of "usually or always using nerve transfers for repairing brachial plexus injuries as 68%, radial nerves as 27%, median as 25%, and ulnar as 33%. They reported using nerve transfers" sometimes for brachial plexus 18%, radial nerve 30%, median nerve 34%, ulnar nerve 35%.

CONCLUSION:

 Taken together this evidence suggests that nerve transfers do offer an alternative technique along with tendon transfers, nerve repair, and nerve grafts.

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Like in all peripheral nerve lesions, the results of a surgical intervention are best when performed within a 6-12 months after the injury.

In leprosy there often is a delay in setting the diagnosis of nerve function loss, while the immune system can continue to affect the peripheral nerve fibers for considerable time after starting medical treatment. Both these factors may affect the outcome of this type of surgery in leprosy.

Nevertheless, there is a clear need for more research on the effectiveness of nerve surgery (nerve grafting, nerve transfers and nerve decompression) in leprosy, as the medical treatment of neuritis too often fails to lead to a functional restoration of nerve function.

Unfortunately, research proposals are still waiting for funding to be effectuated!

With best regards,

Wim

Willem J.Theuvenet, M.D., Ph.D

Plastic, Reconstructive and European Board Certified Hand Surgeon.

Consultant for TLMI and the NLR.

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LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com