Nerve Grafting in the Upper Extremity by Using the Microscope and Microscopic Techniques: A Long-Term Follow-Up of 130 Cases

Abstract

The purpose of the study was to demonstrate that autogenous nerve grafting can give rewarding results providing that certain techniques can be applied. There were 130 cases in all; 70 involved the median nerve, 40 the ulnar nerve, and 20 the radial nerve. There were 85 males and 45 females, ranging in age from 20 to 60 years. The time of the injury to grafting was from 6 months to 5 years. Follow-up ranged from 2 to 15 years. The procedure consisted of exploring the injured peripheral nerve, with excision of neuromas and insertion of autogenous nerve grafts that were taken from the lower extremities. The grafts were approximated to the proximal and distal ends of the injured nerve under the microscope by using fine instruments and microsurgical techniques. Motor recovery for median nerve low lesions, i.e., recovery of the thenar muscles to the M3–M4 level was excellent in 38%, for M2–M3 was good in 40%, and for M1–M2 was fair in 20%. Ulnar nerve motor recovery for intrinsics to level M3–M4 was excellent in 38%; for level M2–M3 was good in 40%; for level M1–M2 was fair in 22%. Motor recovery for radial nerve extensors of the wrist, fingers, and thumb to level M3–M4 was excellent in 38%; for level M2–M3 was good in 38%; for level M1–M2 was fair in 20%. In a large number of patients, this method has considerably improved the function of the extremity. It has provided superior results to those before the use of the microscope and microsurgical instruments. By doing nerve grafting, one avoids excessive mobilization of nerve ends, stretching, suturing under tension, and immobilizing of joints.