Peripheral Nerve Injuries in Children
Authors:
I. Humhej; M. Sameš
Authors‘ workplace:
Neurochirurgická klinika UJEP, Masarykova nemocnice v Ústí nad Labem o. z., Krajská zdravotní a. s.
přednosta prof. MUDr. M. Sameš, CSc.
Published in:
Čes-slov Pediat 2015; 70 (1): 20-28.
Category:
Original Papers
Overview
Aim of the study:
Purpose of this study is to evaluate peripheral nerve (PN) regeneration after microsurgical reconstruction in our series of PN injuries in children, to identify the best surgical technique and its timing and to describe the post-operative care and the follow-up schedule. The pitfalls and the alternate management if the primary surgical reconstruction fails are provided.
Material and methods:
We retrospectively evaluated a series of children treated at our institution between 1999 and 2012. In this 14-year period 67 lesions in 60 patients (45 males, 15 females) were identified. Mean age was 12.3 years. 44 injuries constituted the completely transected PN, 20 partially and 3 lesions were concluded as traction injuries. The median nerve was the most frequently severed, followed by the ulnar nerve, typically at the wrist/distal forearm. The most common cause was a fall through the glass door. 48 lesions (80%) were treated immediately, 7 (12%) in a delayed fashion and 5 (8%) late. Direct microsuture was performed in 54 (81%) lesions; exoneurolysis in 6 (9%); and the autograft interposition was used in 7 lesions (10%).
Results:
26 children with 31 lesions completed 2-year follow-up period, 26 lesions in this subgroup (84%) recovered successfully (defined as motor function ≥M4 and sensory ≥S3 per B.M.R.C.). 5 (16%) recovered unsatisfactorily and in 4 of them we performed a secondary tendon transfer with good functional outcome.
Conclusion:
Peripheral nerves in children show remarkable regeneration capabilities and an immediate repair yields very good outcome. We advocate that the nerve repair should be performed in a timely manner to prevent more complicated reconstruction procedures with worse functional outcome.
Key words:
peripheral nerve, injury, suture, autologous graft, reconstruction, microsurgical technique, neurosurgery, physiotherapy, electrical stimulation, splint, tendon transfer
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Labels
Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2015 Issue 1
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