Results of restoration of continuity in peripheral nerves in childhood and adolescence
Koller, R.; Rath, T.; Benditte-Klepetko, H.; Eberhard, D.; Millesi, H.
Handchirurgie Mikrochirurgie Plastische Chirurgie Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefasse Organ der V. 30(2): 109-115
1998
ISSN/ISBN: 0722-1819 PMID: 9592698 Document Number: 486693
According to several studies, results after reconstructive procedures in children are generally superior compared to those in adults. In the present retrospective study, 20 patients after reconstruction of one or more major nerves in the upper limb (median, ulnar, and radial nerves) were examined. At the time of operation, the patients' age was 8.9 years on the average, the follow-up time ranged between 29 and 173 months. In six cases the nerve lesion had been treated by direct nerve coaptation, in 14 patients a primary or secondary nerve grafting procedure had been applied. The results were classified according to Millesi's examination system, which takes several factors such as mobility, sensibility, skill, and force of the hand into account. Besides two patients, one after reconstruction of the median and ulnar nerves by grafts with significant destruction of the muscles in the lower arm, and the second one after primary coaptation of the median and ulnar nerves in the elbow region, all patients showed a hand function of more than 70% according to Millesi's scoring system. In patients older than ten years at the time of the reconstructive procedure, results were slightly worse than in younger individuals. Children up to ten years of age were nearly always able to move their hand and fingers normally. The results after nerve grafting were sometimes even superior to those after primary neurorrhaphy. Therefore, the present study supports the findings of previous authors describing the excellent regenerative potential of the growing peripheral nervous system. Furthermore, Millesi's scoring system better revealed some subtle differences in hand function when compared to other classifications.