COMPARATIVE STUDY BETWEEN SURAL NERVE GRAFT AND SAPHENOUS VEIN CONDUIT IN GAPPED PERIPHERAL NERVES INJURIES

Abstract

The purpose of this study was to make a comparison between the vein graft conduit as a newly promising technique and sural nerve graft as a conventional standard technique in repairing gapped peripheral nerve injury. This prospective study was performed on 20 patients with completely severed and gapped major peripheral nerves of the upper limb; (Sunderland IV & V) in the period from October 2008 till November 2012. The patients were divided into two groups, A & B. Patients in Group A (8 males & 2 females) had been treated by sural nerve graft. Group B (9 males & 1 female) had been treated by a segment from long saphinous vein graft as a vein conduit. The surgical exploration and graft interposition for both groups were done at least four weeks after the injury. All the patients were evaluated preoperatively both clinically and electrophysiologically and consented about either techniques in the study. Both groups underwent postoperative clinical and electrophysiological assessment over a mean follow up period of 13.3 months. Medical Research Council modified by Mackinnon and Dellon, is grading system used for the evaluation of both motor and sensory return (nerve recovery). Satisfactory functional recovery was 90% in group A, whereas it was just 60% in group B. In both groups the EMG changes were compatible with clinical changes (either improved or not). There is an important relationship between the results of functional recovery and specific factors. These factors were age of the patient, duration of injury, causative agent, type and level of injured nerve, presence or absence of associated vascular and /or tendon injury, the length of intra operative nerve gap, number of cables (group A) and the follow up period. This study demonstrated that we should put autogenous vein conduit graft in our mind in gapped peripheral nerve injury repair, but this technique is less acceptable than conventional standard technique of sural nerve graft. For the future, the use of vein as a conduit for repair and reconstruction of cut nerves may have interesting potential, since such a structure allows several materials such as neurotrophic agents (nerve growth factor) to be introduced into the lumen of the conduit. The effects of a nerve injury can be devastating. We hope that in the future, more successful treatments will be available. In the meantime, clinicians, physiotherapists, occupational therapists and the greater multidisciplinary team involved, will undoubtedly continue to provide expertise and outstanding care.