Posttraumatic neuroma of the radial nerve treated with an autogenous epineural conduit technique. A case report.

We present the outcome of the first clinical application of a new technique using an epineural flap to bridge a short nerve defect. A 28-year-old male had suffered a radial nerve laceration at the lower third of the arm, proximal to the brachioradialis branch, 3 weeks before surgery. During surgery, a neuroma-in-continuity was excised preserving the epineural sleeve. Two longitudinal epineural flaps were created, one from the proximal and one from the distal nerve stump and used to bridge a 1-cm-long nerve defect. Each epineurium flap was sutured to the intact epineurium of the other side and additionally to each other. An electromagnetic nerve stimulator was used to enhance the nerve regeneration process. Nerve regeneration was followed up for 17 months with excellent functional results.

A new technique of autogenous conduits for bridging short nerve defects. An experimental study in the rabbit.

BACKGROUND: [corrected] Nerve grafting is the most reliable used procedure to bridge a neural defect, but it is associated with donor site morbidity. In experimental surgery the search for an optimal nerve conduit led to the use of biological and artificial material. Nerve regeneration through epineural conduits for bridging short nerve defect was examined. METHODS: Four groups including 126 New Zealand rabbits were used. There were 3 study groups (A, B and C) and 1 control group (D). A 10-mm long sciatic nerve defect was bridged either with 3 variations of an epineural flap (Groups A, B and C) or with a nerve graft (Group D). Animals from all groups were examined 21, 42 and 91 days postoperatively to evaluate nerve regeneration employing light microscopy and immunocytochemistry. Nerve regeneration was studied in transverse sections at 3, 6 and 9 mm from the proximal stump. Using muscle stimulator the gastrocnemius contractility was examined at 91 days post surgery in all groups. FINDINGS: Immunohistochemical and functional evaluation showed nerve regeneration resembling the control group, especially in group A, were an advancement epineural flap was used. CONCLUSION: An epineurial flap can be used to bridge a nerve defect with success.