ABSTRACT
In this study, an updated meta-analysis of all published human studies was presented to evaluate the recovery of the median and the ulnar nerves in the forearm after defect repair by nerve conduit and autologous nerve graft. Up to June of 2010, search for English language articles was conducted to collect publications on the outcome of median or ulnar nerve defect repair. A total of 33 studies and 1531 cases were included in this study. Patient information was extracted from these publications and the postoperative outcome was analyzed using meta-analysis. There was no significant difference in the postoperative recovery between the median and the ulnar nerves (odds ratio = 0.98). Sensory nerves were found to achieve a more satisfactory recovery after nerve defect repair than motor nerves (p < 0.05). Median nerve can also achieve more satisfactory recovery in both sensory and motor function than ulnar nerve (p < 0.05). There was no statistical difference between tubulization and autologous nerve graft in repairing defects less than 5 cm. Based on the results of this study, a median nerve with sensory impairment was associated with improved postoperative prognosis, while an ulnar nerve with motor nerve damage was prone to a worse prognosis. Tubulization can be a good alternative in the reconstruction of small defects.
KEYWORDS
Nerve repair - autologous graft - tubulization
REFERENCES
-
1
Jaquet J B, Luijsterburg A J, Kalmijn S, Kuypers P D, Hofman A, Hovius S E.
Median, ulnar, and combined median-ulnar nerve injuries: functional outcome and return to productivity.
J Trauma.
2001;
51
(4)
687-692
-
2
Ichihara S, Inada Y, Nakamura T.
Artificial nerve tubes and their application for repair of peripheral nerve injury: an update of current concepts.
Injury.
2008;
39
(Suppl 4)
29-39
-
3
Schlosshauer B, Dreesmann L, Schaller H E, Sinis N.
Synthetic nerve guide implants in humans: a comprehensive survey.
Neurosurgery.
2006;
59
(4)
740-747, discussion 747–748
-
4
Hasegawa T, Nakamura S, Manabe T, Mikawa Y.
Vascularized nerve grafts for the treatment of large nerve gap after severe trauma to an upper extremity.
Arch Orthop Trauma Surg.
2004;
124
(3)
209-213
-
5
Ruijs A C, Jaquet J B, Kalmijn S, Giele H, Hovius S E.
Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair.
Plast Reconstr Surg.
2005;
116
(2)
484-494, discussion 495–496
-
6
Merle M, Dellon A L, Campbell J N, Chang P S.
Complications from silicon-polymer intubulation of nerves.
Microsurgery.
1989;
10
(2)
130-133
-
7
Lundborg G, Dahlin L B, Danielsen N.
Ulnar nerve repair by the silicone chamber technique. Case report.
Scand J Plast Reconstr Surg Hand Surg.
1991;
25
(1)
79-82
-
8
Lundborg G, Rosén B, Abrahamson S O, Dahlin L, Danielsen N.
Tubular repair of the median nerve in the human forearm. Preliminary findings.
J Hand Surg [Br].
1994;
19
(3)
273-276
-
9
Lundborg G, Rosén B, Dahlin L, Danielsen N, Holmberg J.
Tubular versus conventional repair of median and ulnar nerves in the human forearm: early results from a prospective, randomized, clinical study.
J Hand Surg Am.
1997;
22
(1)
99-106
-
10
Stanec S, Stanec Z.
Ulnar nerve reconstruction with an expanded polytetrafluoroethylene conduit.
Br J Plast Surg.
1998;
51
(8)
637-639
-
11
Stanec S, Stanec Z.
Reconstruction of upper-extremity peripheral-nerve injuries with ePTFE conduits.
J Reconstr Microsurg.
1998;
14
(4)
227-232
-
12
Braga-Silva J.
The use of silicone tubing in the late repair of the median and ulnar nerves in the forearm.
J Hand Surg [Br].
1999;
24
(6)
703-706
-
13
Donoghoe N, Rosson G D, Dellon A L.
Reconstruction of the human median nerve in the forearm with the Neurotube.
Microsurgery.
2007;
27
(7)
595-600
-
14
Hung V, Dellon A L.
Reconstruction of a 4-cm human median nerve gap by including an autogenous nerve slice in a bioabsorbable nerve conduit: case report.
J Hand Surg Am.
2008;
33
(3)
313-315
-
15
Fan W, Gu J, Hu W et al..
Repairing a 35-mm-long median nerve defect with a chitosan/PGA artificial nerve graft in the human: a case study.
Microsurgery.
2008;
28
(4)
238-242
-
16
Rosson G D, Williams E H, Dellon A L.
Motor nerve regeneration across a conduit.
Microsurgery.
2009;
29
(2)
107-114
-
17
Millesi H, Meissl G, Berger A.
The interfascicular nerve-grafting of the median and ulnar nerves.
J Bone Joint Surg Am.
1972;
54
(4)
727-750
-
18
Walton R, Finseth F.
Nerve grafting in the repair of complicated peripheral nerve trauma.
J Trauma.
1977;
17
(10)
793-796
-
19
Tallis R, Staniforth P, Fisher T R.
Neurophysiological studies of autogenous sural nerve grafts.
J Neurol Neurosurg Psychiatry.
1978;
41
(8)
677-683
-
20
Barrios C, Amillo S, de Pablos J, Cañadell J.
Secondary repair of ulnar nerve injury. 44 cases followed for 2 years.
Acta Orthop Scand.
1990;
61
(1)
46-49
-
21
Singh R, Mechelse K, Hop W C, Braakman R.
Long-term results of transplantations to repair median, ulnar, and radial nerve lesions by a microsurgical interfascicular autogenous cable graft technique.
Surg Neurol.
1992;
37
(6)
425-431
-
22
Vastamäki M, Kallio P K, Solonen K A.
The results of secondary microsurgical repair of ulnar nerve injury.
J Hand Surg [Br].
1993;
18
(3)
323-326
-
23
Kallio P K, Vastamäki M.
An analysis of the results of late reconstruction of 132 median nerves.
J Hand Surg [Br].
1993;
18
(1)
97-105
-
24
Kalomiri D E, Soucacos P N, Beris A E.
Nerve grafting in peripheral nerve microsurgery of the upper extremity.
Microsurgery.
1994;
15
(7)
506-511
-
25
Daoutis N K, Gerostathopoulos N E, Efstathopoulos D G, Misitizis D P, Bouchlis G N, Anagnostou S K.
Microsurgical reconstruction of large nerve defects using autologous nerve grafts.
Microsurgery.
1994;
15
(7)
502-505
-
26
Trumble T E, Kahn U, Vanderhooft E, Bach A W.
A technique to quantitate motor recovery following nerve grafting.
J Hand Surg Am.
1995;
20
(3)
367-372
-
27
Shen N, Zhu J.
Functional assessment of peripheral nerve injury and repair.
J Reconstr Microsurg.
1996;
12
(3)
153-157
-
28
Polatkan S, Orhun E, Polatkan O, Nuzumlali E, Bayri O.
Evaluation of the improvement of sensibility after primary median nerve repair at the wrist.
Microsurgery.
1998;
18
(3)
192-196
-
29
Kato H, Minami A, Kobayashi M, Takahara M, Ogino T.
Functional results of low median and ulnar nerve repair with intraneural fascicular dissection and electrical fascicular orientation.
J Hand Surg Am.
1998;
23
(3)
471-482
-
30
Amillo S, Mora G.
Surgical management of neural injuries associated with elbow fractures in children.
J Pediatr Orthop.
1999;
19
(5)
573-577
-
31
Kim D H, Kam A C, Chandika P, Tiel R L, Kline D G.
Surgical management and outcomes in patients with median nerve lesions.
J Neurosurg.
2001;
95
(4)
584-594
-
32
Kim D H, Han K, Tiel R L, Murovic J A, Kline D G.
Surgical outcomes of 654 ulnar nerve lesions.
J Neurosurg.
2003;
98
(5)
993-1004
-
33
Roganovic Z.
Missile-caused ulnar nerve injuries: outcomes of 128 repairs.
Neurosurgery.
2004;
55
(5)
1120-1129
-
34
Roganovic Z, Pavlicevic G.
Difference in recovery potential of peripheral nerves after graft repairs.
Neurosurgery.
2006;
59
(3)
621-633, discussion 621–633
-
35
Secer H I, Daneyemez M, Gonul E, Izci Y.
Surgical repair of ulnar nerve lesions caused by gunshot and shrapnel: results in 407 lesions.
J Neurosurg.
2007;
107
(4)
776-783
-
36
Terzis J K, Kokkalis Z T.
Outcomes of secondary reconstruction of ulnar nerve lesions: our experience.
Plast Reconstr Surg.
2008;
122
(4)
1100-1110
-
37
Secer H I, Daneyemez M, Tehli O, Gonul E, Izci Y.
The clinical, electrophysiologic, and surgical characteristics of peripheral nerve injuries caused by gunshot wounds in adults: a 40-year experience.
Surg Neurol.
2008;
69
(2)
143-152, discussion 152
-
38
Murovic J A.
Upper-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Center literature review with comparison of the operative outcomes of 1837 Louisiana State University Health Sciences Center median, radial, and ulnar nerve lesions.
Neurosurgery.
2009;
65
(4, Suppl)
A11-A17
-
39 Mackinnon S, Dellon A L. Surgery of the Peripheral Nerve. New York: Thieme; 1988: 637
-
40
Battiston B, Geuna S, Ferrero M, Tos P.
Nerve repair by means of tubulization: literature review and personal clinical experience comparing biological and synthetic conduits for sensory nerve repair.
Microsurgery.
2005;
25
(4)
258-267
-
41
Temple C.
A primer in meta-analysis for the plastic surgeon.
Ann Plast Surg.
2010;
64
(4)
506-509
-
42
Dahlin L B, Lundborg G.
Use of tubes in peripheral nerve repair.
Neurosurg Clin N Am.
2001;
12
(2)
341-352
-
43
Colen K L, Choi M, Chiu D T.
Nerve grafts and conduits.
Plast Reconstr Surg.
2009;
24
(6, Suppl)
e386-e394
-
44
Saur K, Bartos R, Sames M.
Results of reinnervation after peripheral nerve repair by a microsurgical technique used in 1996-1998. [in Czech] Acta Chir Orthop Traumatol Cech
2004;
71
(5)
297-302
-
45
Taha A, Taha J.
Results of suture of the radial, median, and ulnar nerves after missile injury below the axilla.
J Trauma.
1998;
45
(2)
335-339
-
46
Kannan R Y, Salacinski H J, Butler P E, Seifalian A M.
Artificial nerve conduits in peripheral-nerve repair.
Biotechnol Appl Biochem.
2005;
41
(Pt 3)
193-200
-
47
Bushnell B D, McWilliams A D, Whitener G B, Messer T M.
Early clinical experience with collagen nerve tubes in digital nerve repair.
J Hand Surg Am.
2008;
33
(7)
1081-1087
-
48
Dahlin L B, Anagnostaki L, Lundborg G.
Tissue response to silicone tubes used to repair human median and ulnar nerves.
Scand J Plast Reconstr Surg Hand Surg.
2001;
35
(1)
29-34
Feng ZhangM.D. Ph.D.
Division of Plastic Surgery, Department of Surgery, University of Mississippi Medical Center
2500 North State Street, Jackson, MS 39216
eMail: fzhang@umc.edu
