End-to-side neurorrhaphy of sensory nerves

Abstract

One century passed before end-to-side 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 end-to-side 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 end-to-side nerve suture are reported. We began to use end-to-side 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 end-to-side neurorrhaphy was performed in digital avulsion injuries. In one patient the avulsed ulnar nerve of the thumb was sutured end-to-side 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 end-to-side to the radial nerve of the same finger. Sensory recovery was obtained in both patients. The static two-point discrimination was 3.0 mm, and dynamic two-point discrimination was 2–3 mm for the reinnervated finger compared to 2 mm for static and dynamic two-point 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 end-to-side nerve suture. Proximal avulsion, missing proximal nerve stumps, partial recovery, and prevention of nerve grafts are good indications for resensitization using end-to-side neurorrhaphy. No harm to the donor nerve is expected. Preference should be given to donor nerves that supply skin areas near to the anesthetic area.