Experience with peripheral nerve injury in lower extremities

This study reports the results of 43 operations performed on nerves of lower extremities of 43 patients during a period of 7 years from 1999 - 2005 in Mansoura University Hospital and Mansoura Emergency Hospital. There were 15 patients with isolated sciatic nerve injury, 24 with isolated peroneal nerve injury and 4 with isolated tibial nerve injury. All patients were treated with nerve exploration within 1 hour to 7 months after injury and were followed-up for 6 months to 4 years. There were 22 nerve lesions not in continuity [9 needed suture repair and 13 needed sural nerve graft repair], while 21 nerve lesions were in continuity [16 partial lesions needed neurolysis and 5 complete lesions needed neuroma excision and suture repair]. Analysis of the outcome of surgical treatment was performed with respect to the following parameters: period between the injury and operation, patient age, type of injured nerve, mechanism of injury and type of surgical intervention. Overall significant outcome [>/= 3 Louisiana State University Health Science grade] was obtained in 53.5% [sciatic nerve 46%, peroneal nerve 54% and tibial nerve 75%]. According to the type of intervention and lesion categories; lesions not in continuity had a significant outcome 41% [suture repair 55.5% while graft repair 31%], and lesions in continuity had a significant outcome 67% [lesions underwent neurolysis 75%, while lesions underwent suture repair 40%]. Useful function was achieved in 3 [43%] of 7 patients with grafts less than 6 cm in length and in only 1 [16%] of 6 patients with grafts greater than 6 cm in length. The mean time to recovery in patients who underwent surgery was 18 months [range: 1- 32/ ]. In conclusion, the most favourable outcome was obtained with lesions that result in partial lesion in continuity. Considering the rate of spontaneous recovery of post-injection nerve injuries of the sciatic nerve and early onset of skeletal deformities, a closed nerve injury of the lower limb with no recovery within 3 months should always undergo surgery, even if complete functional outcome is not always guaranteed

Neurovascular injury after anterior cruciate ligament reconstruction: a case report and review of the literature

Injury to the popliteal artery and tibial nerve following harvesting of the medial hamstring tendons is a complication that has not been described. We report a unique case of popliteal artery and tibial nerve injury following hamstring graft harvest for the use in ACL reconstruction. The popliteal artery and tibial nerve anatomy and technique of graft harvest are briefly described

Effect of tension on force of contraction of muscle and nerve conduction velocity of the repaired nerve in a rat model.

To investigate the effect of tension on the contractive force of muscle and nerve conduction velocity of the repaired nerve, this study was designed. Fifty-four Sprague-Dawley (SD) rats were randomly divided into 3 groups. The left gastrocnemius muscles of the rats were dissected with the neurovascular pedicles intact; the tibial nerves were cut and immediately repaired by epineurial suture. Then the Achilles tendons were isolated and treated accordingly; the Achilles tendon was lengthened by 0.5 cm in lengthened group, shortened by 0.5 cm in shortened group and left alone in normal (control) group. In the 2nd, 4th and 8th weeks after operation, the isometric twitch contractive force of both the right and the left gastrocnemius muscles and the nerve conduction velocity (NCV) of the tibial nerve were measured. The shortened group showed greater isometric twitch contractive strength of the bilateral gastrocnemius muscles than those in the normal and lengthened groups in all the postoperative periods. The nerve conduction velocity (NCV) in the shortened group showed greater than other groups. A proper high tension of the muscle can increase the contraction of the muscle and may improve the nerve conduction velocity of the repaired nerve.

Does the Tibial and Sural Nerve Transection Model Represent Sympathetically Independent Pain?

Neuropathic pain can be divided into sympathetically maintained pain (SMP) and sympathetically independent pain (SIP). Rats with tibial and sural nerve transection (TST) produce neuropathic pain behaviors, including spontaneous pain, tactile allodynia, and cold allodynia. The present study was undertaken to examine whether rats with TST would represent SMP- or SIP-dominant neuropathic pain by lumbar surgical sympathectomy. The TST model was generated by transecting the tibial and sural nerves, leaving the common peroneal nerve intact. Animals were divided into the sympathectomy group and the sham group. For the sympathectomy group, the sympathetic chain was removed bilaterally from L2 to L6 one week after nerve transection. The success of the sympathectomy was verified by measuring skin temperature on the hind paw and by infra red thermography. Tactile allodynia was assessed using von Frey filaments, and cold allodynia was assessed using acetone drops. A majority of the rats exhibited withdrawal behaviors in response to tactile and cold stimulations after nerve stimulation. Neither tactile allodynia nor cold allodynia improved after successful sympathectomy, and there were no differences in the threshold of tactile and cold allodynia between the sympathectomy and sham groups. Tactile allodynia and cold allodynia in the neuropathic pain model of TST are not dependent on the sympathetic nervous system, and this model can be used to investigate SIP syndromes.

Does the Tibial and Sural Nerve Transection Model Represent Sympathetically Independent Pain?

Neuropathic pain can be divided into sympathetically maintained pain (SMP) and sympathetically independent pain (SIP). Rats with tibial and sural nerve transection (TST) produce neuropathic pain behaviors, including spontaneous pain, tactile allodynia, and cold allodynia. The present study was undertaken to examine whether rats with TST would represent SMP- or SIP-dominant neuropathic pain by lumbar surgical sympathectomy. The TST model was generated by transecting the tibial and sural nerves, leaving the common peroneal nerve intact. Animals were divided into the sympathectomy group and the sham group. For the sympathectomy group, the sympathetic chain was removed bilaterally from L2 to L6 one week after nerve transection. The success of the sympathectomy was verified by measuring skin temperature on the hind paw and by infra red thermography. Tactile allodynia was assessed using von Frey filaments, and cold allodynia was assessed using acetone drops. A majority of the rats exhibited withdrawal behaviors in response to tactile and cold stimulations after nerve stimulation. Neither tactile allodynia nor cold allodynia improved after successful sympathectomy, and there were no differences in the threshold of tactile and cold allodynia between the sympathectomy and sham groups. Tactile allodynia and cold allodynia in the neuropathic pain model of TST are not dependent on the sympathetic nervous system, and this model can be used to investigate SIP syndromes.

Manifestaciones neurológicas de la lepra / Neurologic manifestation of the leprosy

La lepra es siempre una enfermedad cutánea y nerviosa periférica. Existen formas clínicas bien definidas localizadas en los troncos nerviosos: cara, cuello, miembros, dando la clásica mononeuritis múltiple. El primer lugar le corresponde al cubital, seguido por el ciático poplíteo externo. Según cifras estadísticas y nuestra propia experiencia hay predominancia para el cubital en la gotera oleacraneana respecto de la palma y en la cabeza del peroné para el ciático poplíteo externo respecto del hueco poplíteo. El engrosamiento nervioso es facilmente palpable y aún visible. Se hace la descripción anatómica y funcional siguiendo a Guy Lazorthes y la interpretación de la biomecánica en base a los estudios y aportes de Manzi, R.O y colaboradores, con las consecuencias ulcerotróficas del disbalance muscular. El panadizo analgésico y el mal perforante plantar son dos cuadros habituales en la lepra. No así el absceso del nervio y el síndrome hombro-mano-dedos. Se citan referencias en nuestro país. Nuestro material es recopilado del Hospital Perrando y servicio de Dermatología de Resistencia. Se observó predominancia de formas múltiples además de formas lepromatosas. En la fisiopatogenia se hace referencia al estado de hibernación en que vive el bacilo en la vaina de Schwann, ya que éste vive años a cambio del histiocito que no vive más de una semana. Como resultado de un conflicto local donde intervienen fenómenos tisulares, inmunológicos y circulatorios, se producen, de acuerdo a la capacidad del huésped, las distintas formas de lepra: tuberculoide, lepromatosa, dimorfa e incaracterística. Se describe otra forma que es la neuritis autoinmune secundaria de Languillon y Carayon como expresión de pérdida de alergia tisular. La isquemia del nervio es la condicionante de la lesión neural que lleva a la esclerosis. La liberación del tronco del canal por sección de fibras de inserción muscular y la neurolisis con epineurotomía son propuestas como los medios más útiles para la cirugía, cuando se han agotado los recursos médicos conservadores

Tratamiento quirúrgico de neuritis hansenianas / Surgical treatment of hansenian neuritis

Los autores analizan los problemas del tratamiento quirúrgico de las neuritis hansenianas. Se establecen los criterios que deben ser utilizados. Ubican la cirugía en el contexto terapéutico. Presentan ejemplos de su casuística. Se sugiere uniformar los criterios a fin de tornar comparativos los resultados