Long-term follow-up of three different nerve repair strategies (repair, autografting and allografting) in one-stage replantation to treat upper extremity amputation

Abstract

Objective To examine the efficacy of three different nerve repair methods for one-stage replantation to treat complete upper extremity amputation and long-term postoperative functional recovery.

Methods Twenty-five patients underwent direct nerve anastomosis (Group A), for patients with nerve defects greater than 3 cm, nerve autograft transplantation be used (Group B), or patients with nerve defects less than 3 cm, nerve allograft transplantation be used (Group C) based on the severity of injury. The Disabilities of the Arm, Shoulder, and Hand (DASH) score (higher score means poorer function-less than 25 means good effect) and visual analogue scale (VAS) scores for pain at rest and under exertion were measured. Sensation recovery time and grip function were recorded.

Results The mean follow-up time was 78 ± 29 months. Group A had the lowest DASH score, while Group C had the highest DASH score. DASH score differed significantly between the three groups (P < 0.001). Sensation was not restored in two patients in Group B and two patients in Group C, and there were significant between-group differences in sensation recovery (P = 0.001). Group C had the lowest VAS score, while Group A had the highest, and there were significant differences between groups (P = 0.044). Only one patient in Group C recovered grip function.

Conclusion Direct nerve anastomosis should be performed whenever possible in replantation surgery for complete upper extremity amputation, as the nerve function recovery after direct nerve anastomosis is better than that after nerve autograft transplantation or nerve allograft transplantation. Two-stage nerve autograft transplantation can be performed in patients who do not achieve functional recovery long after nerve allograft transplantation.

Zusammenfassung

Ziel Untersuchung der Wirksamkeit dreier verschiedener Verfahren zur Rekonstruktion von Nerven bei einzeitiger Replantation zur Behandlung vollständiger Amputationen der oberen Extremität sowie der langfristigen postoperativen Wiederherstellung der Nervenfunktion.

Methoden Bei 25 Patienten wurde eine direkte Nervenanastomose durchgeführt (Gruppe A); bei Patienten mit Nervendefekten von mehr als 3 cm erfolgte eine Autotransplantation (Gruppe B) und bei Patienten mit Nervendefekten unter 3 cm eine Allotransplantation (Gruppe C), basierend auf der Schwere der Schädigung. Gemessen wurden der DASH-Score („Disabilities of the Arm, Shoulder and Hand“), bei dem ein höherer Punktwert auf eine schlechtere Funktion und ein Punktwert von weniger als 25 auf einen guten Effekt hinweist, sowie die Scores der visuellen Analogskala (VAS) für Schmerzen in Ruhe und unter Belastung. Außerdem wurden die Zeit bis zur Wiederherstellung der sensorischen Funktion sowie die Greiffunktion dokumentiert.

Ergebnisse Die mittlere Nachbeobachtungszeit lag bei 78 ± 29 Monaten. Gruppe A wies den niedrigsten DASH-Score auf, Gruppe C den höchsten. Der DASH-Score unterschied sich zwischen den 3 Gruppen signifikant (p < 0,001). Bei 2 Patienten in Gruppe B und 2 Patienten in Gruppe C konnte die sensorische Funktion nicht wiederhergestellt werden und es wurden signifikante Unterschiede bei der Wiederherstellung der Sensorik zwischen den Gruppen festgestellt (p = 0,001). Gruppe C wies den niedrigsten VAS-Score auf, Gruppe A den höchsten, und es fanden sich signifikante Unterschiede zwischen den Gruppen (p = 0,044). Nur ein Patient in Gruppe C erlangte seine Greiffunktion wieder.

Schlussfolgerung In der Replantationschirurgie bei vollständiger Amputation der oberen Extremität ist eine direkte Nervenanastomose anzustreben, da nach einer direkten Nervenanastomose eine bessere Wiederherstellung der Nervenfunktion erreicht wird als nach einer Auto- oder Allotransplantation. Eine zweizeitige Autotransplantation kann bei Patienten erfolgen, die lange Zeit nach einer Allotransplantation keine Funktionswiederherstellung erreichen.

Key words

Complete amputation - nerve anastomosis - nerve allograft transplantation - microsurgery - macro-replantation

Schlüsselwörter

Nervenanastomose - Mikrochirurgie - Makroreplantation - Autotransplantation von Nerven

Publication History

Received: 13 April 2021

Accepted: 17 August 2021

Article published online:
07 December 2021

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