Nerve Conduction Study Findings in Ulnar-Median Nerve Intercommunications in the Upper Limb: A Short Review

Intercommunications between ulnar and median nerves in the forearm and hand are a commonly encountered phenomenon. Clinicians should be aware of these communications for better diagnosis and management of the patient, as the clinical presentation can often be misleading. Surgeons should be aware of these anastomoses so as to prevent any iatrogenic injury during the course of treatment. Furthermore, these intercommunications can distort the findings on nerve conduction studies, leading to misinterpretation and misdiagnosis. In the forearm region, there are two prominent median-ulnar anastomoses, namely, Martin–Gruber anastomosis (MGA) and reverse MGA (Marinacci anastomosis). Similarly, in the palm too, there are two major anastomoses, namely, Riche–Cannieu anastomosis and Berrittini anastomosis. Here, in this review, we would like to emphasize on electrophysiological findings that can be observed in the presence of such anastomoses.

An Experimental Study on the Optimal Timing for the Repair of Incomplete Facial Paralysis by Hypoglossal-facial 'Side'-to-side Neurorrhaphy in Rats / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the optimal timing for the repair of persistent incomplete facial paralysis by hypoglossal-facial 'side'-to-side neurorrhaphy in rats.</p><p><b>METHODS</b>A total of 30 adult rats with crushed and bulldog-clamped facial nerve injury were randomly divided into 5 groups (n = 6 each) that were subjected to injury without nerve repair or with immediate repair, 2-week-delayed repair, 4-week-delayed repair, or 8-week-delayed repair. Three months later, the effects of repair in each rat were evaluated by facial symmetry assessment, electrophysiological examination, retrograde labeling, and axon regeneration measurement.</p><p><b>RESULTS</b>At 3 months after injury, the alpha angle significantly increased in the group of rats with 4-week-delayed repair compared with the other four groups. Upon stimulation of the facial nerve or Pre degenerated nerve, the muscle action potentials MAPs were recorded in the whisker pad muscle, and the MAP amplitude and area under the curve in the 4-week-delayed repair group were significantly augmented at 3 months post-injury. Similarly, the number of retrograde-labeled motor neurons in the facial and hypoglossal nuclei was quantified to be significantly greater in the 4-week-delayed repair group than in the other groups, and a large number of regenerated axons was also observed.</p><p><b>CONCLUSION</b>The results of this study demonstrated that hemiHN-FN neurorrhaphy performed 4 weeks after facial nerve injury was most effective in terms of the functional recovery of axonal regeneration and activation of facial muscles.</p>

Preliminary study on superior trapezius myocutaneous flap through accessory nerve anastomosis in reconstructing the tongue defect after the operation of tongue squamous cell carcinoma / 重庆医学

Objective To explore the clinical effects of superior trapezius myocutaneous flap through accessory nerve anastomosis in immediately repairing the tongue defect after tongue squamous cell carcinoma operation.Methods Six cases of tongue squamous cell carcinoma diagnosed by pathology in the Maxillofacial Surgery Department of the Affiliated Stomatological Hospital of Chongqing Medical University from January 2015 to December 2016 were collected and Performed the tongue-neck combined radical operation.The superior trapezius myocutaneous flap simultaneous repair of tongue defect with accessory nerve and hypoglossal anastomosis was adopted during operation.The wound surface of donor site was directly sutured without skin grafting.Results All flaps survived.After 6 months to one year,the flap became mucolized,the surface of flap was similar to the normal oral mucosa with good character.The movement of reconstructed tongue mainly depended on the movement of residual tongue at early stage (within postoperative 3 months).After 6 monthsthe reconstructed tongue had obvious mobility,but the flexibility was poorer than that of the uninjured side,and the patient was satisfied with the language and swallowing function.Conclusion The superior trapezius myocutaneous flap through the accessory nerve anastomosis is one of the ideal skin flaps for repairing tongue defect after e tongue squamous cell carcinoma operation.

Experimental study of reconstruction of hindlimp movement with spinal ventral root anastomoses after spinal cord injury in rats / 中华显微外科杂志

Objective To establish a paraspinal neural pathway of quadriceps femoris by end-to-end anastomoses between the spinal ventral root after spinal cord injury(SCI) in rats. Methods Twenty-fourweek old SD rats, with the weight of 120 g to 150 g, were included. The left side was the experimental side, while the right side served as a control. Electrostimulating of L1-L5 ventral root was done respectively to decide the predominant nerve of quadriceps femoris. The lumbar 1 ventral root was reveal to little innervation of quadriceps femoris, and the lumbar 3 ventral root was predominant innervation. End-to-end anastomosis between the left L1 and L3 ventral root was done. After axona regeneration, the new paraspinal neural pathway of quadriceps femoris was established. At 6 months postoperatively, the early function of the new pathway was observed by electrophysiological examinations, hindlimb locomotion and BBB (basso, beattie and bresnahan)scale at 1,3,7, 14,21,28 d after SCI. Results Sixteen rats survived for 6 months after operation and only ten rats got good results because of tissue adhesion postoperatively. Single stimuli (2.5 mA,0.2 ms, 1 Hz) of the left anastomoses nerve resulted in action potential recorded from the left quadriceps femoris before and after the spinal cord hemisection horizontally between L2 segmental levels. The amplitudes of the action potentials were (7.63 ± 1.86) mV and (6.00 ± 1.92)mV, respectively, and there was no significant difference (P ＞ 0.05). The left quadriceps femoris contraction was initiated by single stimuli (2.5mA, 0.2 ms, 1 Hz) of the left anastomoses nerve. After paraplegia, when the right L3 ventral root was stimulated, the amplitude of the action potential was (15.87 ± 1.16) mV. Locomotion of the left hindlimb was partially restored after spinal cord hemisection while creeping and climbing. According to BBB scale, there was significant difference at 1, 3, 7 d, and little difference at 14, 21, 28 d after SCI. Conclusion Spinal ventral roots cross-ananstomosis to reconstruct the paraspinal pathway of quadriceps femoris after SCI is efficient reinnervation of hindlamb muscles in a rat model and may have potential in clinical application.

Surgical treatment of early traumatic injuries to the facial nerve / 中华医学美学美容杂志

Objective To investigate the choices of the timing and methods of the surgical operation after traumatic injuries to the facial nerve, and to emphasize the importance of the excision of perineauial scar,technique of microsurgery with no injuries and the methods selected for nerve coaptation according to the morphologic feature of the injuried nerve.Methods From December 1993 to November 1997, by microsurgical technique, seven cases with traumatic injuries to the facial nerve were treated in two stages from three months to four months after the trauma. Different methods were used including facial nerve anastomosis and implantation of the sural nerve transplant into the muscle. Results All cases have been followed up for six months to two years. The results of functional rehabilitation were excellent. Conclusions Whenever possible, the authors emphasize that the early repair with microsurgical technique should be performed to all of facial nerve with injury. Facial nerve anastomosis is the best choice for repair of early facial nerve severance. Implantation of nerve transplant into muscle has a certain clinical value of and the indication for the treatment of nerve injury.

Livedo Reticularis Idiopathica Associated with Mononeuropathy Multiplex Syndrome and Bilateral Ulnar-median Nerve Anastomosis

A 31-year-old woman had a livedo reticularis of reticulated, bluish discoloration on both arms and legs for 18 months with a burning pain in the right hand and numbness in both lower legs. The findings of the electromyography were consistent with mononeuropathy multiplex and bilateral ulnar-median nerve anastomosis. A biopsy specimen from the right sural nerve showed perivascular lymphocytic infiltration and occasional myelin digestion chambers, which were consistent with vasculitic neuropathy. We present a patient with livedo reticularis idiopathica associated with mononeuropathy multiplex syndrome who also has bilateral ulnar-median nerve anastomosis.