X-ray follow up of end-to-end nerve repair site: A new technique, Nerve Repair Site Marking (NRSM)

Abstract

Objective: An end-to-end nerve repair site always has the risk of rupture and nerve healing failure. In observing the nerve healing site and nerve anastomosis after surgery, here, a new simple and cost-effective technique, “Nerve Repair Site Marking” (NRSM), is defined. Methods: During primary or secondary nerve repair, to see the continuity of the repair site, a new technique was employed - NRSM. After coaptation of the nerve at any site of the body and when repairing under tension, 1cm proximal and 1 cm distal of the suture site, the epineurium was marked with a titanium hemoclip. During the first 6 weeks post-surgery, X-rays of the repair site were taken every week and the distance between the hemoclips was measured. Results: Since 2006, in 23 patients, 25 nerves underwent end-to-end repair (brachial plexus and peripheral nerves), was conducted under tension and if there was the risk of rupture of the repair site, NRSM was employed. All patients were followed up with X-ray of the repair site every week, especially during the first 4 weeks and at the end of 6 weeks. If the patients lived far away from the clinic, they sent their repair site X-rays. Only one patient had rupture of the repair site, and it was just after surgery and repaired immediately. Conclusion: To get the best results following end-to-end nerve repair, nerve continuity must continued, though there is always the risk of rupture at the repair site. As ultrasonography and MRI can be utilized to examine the repair site, they are not helpful in brachial plexus repairs, are expensive and can be time-consuming when employed with peripheral nerves. NRSM is an easy, objective, and cheap follow-up technique after nerve repair and provides a chance for early re-repair.