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Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 123-127

The efficacy of vein ensheathing in protecting peripheral nerve repair sites

1 Department of Plastic Surgery, Queen Elizabeth Hospital, Birmingham, England, United Kingdom
2 Department of Hand Surgery, Queen Elizabeth Hospital, Birmingham, England, United Kingdom

Correspondence Address:
Dr Rajive M Jose
Department of Hand Surgery, Queen Elizabeth Hospital, B15 2WB, Birmingham
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmsr.jmsr_75_18

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Objectives: Peripheral nerve repairs can have a variable outcome depending on several factors. Neuroma in continuity at the repair site may limit functional recovery and is frequently associated with localised pain and sensitivity to mechanical stimulation. Extraneural scar may constrict the repair site, impeding axonal regeneration and resulting in adhesions to the nerve repair bed, reducing nerve glide and causing neurostenalgia. This study looked at the outcomes of using a segment of vein to ensheathe peripheral nerve repair sites in twenty patients to measure efficacy with validated functional outcomes and complications. Methods: This was a retrospective review of twenty cases performed in our unit between 2011 and 2015. Thirteen cases of vein ensheathing were performed to protect primary neurorrhaphy following traumatic lacerations without significant nerve loss. Seven cases were performed in secondary nerve repairs, of which five followed excision of a neuroma and two following neurolysis and repair. Results: There were 19 cases with a follow-up ranging from 24 to 72 months (mean of 32 months). One patient did not respond and was lost to follow-up. Twelve patients attended clinic for the long-term follow-up appointment and seven opted for a telephone evaluation. There were no clinical neuromata identified at the repair sites in the 12 patients attending the research clinic. Eighteen patients reported no scar hypersensitivity and 17 reported some sensory recovery following the repair. Two patients reported no sensory recovery following the nerve repair and 17 had diminished or protective sensations. Twelve patients had formal quantitative sensory testing with two-point discrimination of which two patients achieved only S3 (poor), nine patients achieved S3+ (good), and one achieved S4 (excellent) using the Mackinnon and Dellon classification of sensory recovery. Conclusion: Vein ensheathing is a useful technique which decreases the risk of symptomatic neuromas and adhesions following repair of sensory nerves in the upper limb. However, a randomised controlled trial will be needed to further validate the use of this technique.

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