Endtoside neurorrhaphy of sensory nerves

Authors: M Frey P Giovanoli

Publish Date: 2003/03/28

Volume: 26, Issue: 2, Pages: 85-88

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Abstract

One century passed before endtoside neurorrhaphy was rediscovered and now it finds more frequent use in clinical practice Experimental studies have improved our understanding of the underlying mechanism and its potential However still discussed is whether reinnervation by endtoside neurorrhaphy works as well in sensory nerves as in motor nerves The digital nerves are sensory nerves and therefore an ideal model to investigate this question Two cases of successful sensory reinnervation by endtoside nerve suture are reported We began to use endtoside nerve repair clinically in 1995 and have used it for motor or sensory reinnervation in a total of 13 cases In two patients primary nerve repair using endtoside neurorrhaphy was performed in digital avulsion injuries In one patient the avulsed ulnar nerve of the thumb was sutured endtoside to the median nerve in the other the ulnar digital nerve of the ring finger had been destroyed over a distance of 20 mm and the distal stump was joined endtoside to the radial nerve of the same finger Sensory recovery was obtained in both patients The static twopoint discrimination was 30 mm and dynamic twopoint discrimination was 2–3 mm for the reinnervated finger compared to 2 mm for static and dynamic twopoint discrimination in the adjacent donor finger The sensation of the finger supplied by the donor nerve was not altered in relation to the corresponding contralateral finger site Excellent sensory reinnervation is possible through an endtoside nerve suture Proximal avulsion missing proximal nerve stumps partial recovery and prevention of nerve grafts are good indications for resensitization using endtoside neurorrhaphy No harm to the donor nerve is expected Preference should be given to donor nerves that supply skin areas near to the anesthetic areaWe thank Dr Doris Burg neurologist at the Division of Reconstructive Surgery at the University Hospital in Zurich and Dr Tatjana PaternostroSluga who specializes in electroneurodiagnostic followup studies at the Department of Physical Medicine and Rehabilitation at the University of Vienna for their detailed electroneurodiagnostic studies in our patients Their work made possible an objective evaluation of the results of endtoside neurorrhaphy which was independent of the surgeons treating the patients We thank Mag Susanne Friedl for her great help in preparing the manuscript This research was presented at the 2001 Meeting of the American Society of Reconstructive Microsurgery Coronado Bay Calif 13–16 January 2001 and at the 11th Annual Meeting of the European Association of Plastic Surgeons Berlin 1–3 June 2000

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