Vein Conduit with Microsurgical Suture for Primary Repair of Digital Nerves Injuries

Seance of wednesday 22 october 2014 (CHIRURGIE DE LA MAIN ET DU MEMBRE SUPÉRIEUR - évolutions techniques et thérapeutiques)

Abstract

Results of microsurgical nervous suture are unpredictable. A painful neuroma may occur despite nervous repair. Protecting the nerve with a sleeve isn’t a new concept, but the use of a venous sleeve for the primary repair of a digital nerve is rather uncommon. Surgical procedure consists of an epiperineural suture with a minimum tension (up to 1mm gap) completed by a venous sleeve harvested on the dorsal aspect of the hand.48 consecutive patients with a complete section of one or more digital nerve were operated on. Stretching and crushing injuries were excluded from the study. 53 sleeves were reviewed after a mean follow-up of 25 months. There were no rejection nor complication. Scar at the donor site was minimal. There was no painful neuroma. Sensory recovery was satisfactory or very satisfactory for 96% cases, according to usual neurological parameters.Venous sleeve insulates and prevents painful neuroma after digital nervous repairs. Histological studies on animal advocate biological effects coming from the venous lining assisting nervous regeneration, such as Nerve Growth Factor. This effect is added to the barrier created by the vein which avoids perineural fibrosis.According to these results, venous sleeve is now preformed for any nervous repair, regardless of the injury or location.