Sensory Recovery After Forearm

8/3/2019 Sensory Recovery After Forearm

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Reuf Karabeg, Malik Jakirlic, VanisDujso

Clinic for Plastic and ReconstructiveSurgery, Clinical Center University Of

Sarajevo, BiH

Sensory Recovery After ForearmMedian and Ulnar Nerve Grafting



Median Nerve

A nerve that is formed by the union of the medial andlateral roots from the medial and lateral cords of

the brachial plexus and supplies the muscularbranches in the anterior region of the forearm andthe muscular and cutaneous branches in the hand.

The most common site for lesion of the median

nerve is where it passes through the carpaltunnel. The median nerve is the most sensitivestructure in the tunnel. Loss of coordination andstrength in the thumb may occur. People with carpaltunnel syndrome are unable to oppose the thumb



Nerve Graft

The transplantation of all or part of a nerve. Theprocedure may be performed in cases in whichthe gap in a severed nerve is too large to berepaired by suture alone. The graft provides a

pathway that encourages the regrowth of severedaxons from the central stump of the damagednerve.



Introduction Median and ulnar nerve injuries are common,

whether isolated or combined injury of bothnerve. Recovery of protective sensibility ispossible many years after nerve injury but the

degree of functional sensation preserveddecreases with a delay in nerve repair longerthan 6 months. In complete lesions of peripheralnerve the best is primary reconstruction. A nerve

graft, if performed in a tensionless manner, hasbeen shown to generally have better results thanan end-to-end approximation performed undertension.



Methodology They analyzed the influence of the patients age,

level of injury, the size of the graft and the periodbetween the injury and operation on the lateresults. Patients and methods: Evaluation was

performed in 55 patients with adequate follow-up.

The mean follow-up period was 3,9 years.Reconstructions were applied on the mediannerve in 31 patients and ulnar nerve in 24

patients. Criteria for inclusion in the study wasmedian and ulnar nerve grafting in the forearmregion.



Discussion ulnar nerve injuries result in poorer motor function

than median nerve injuries

No significant difference was found in many largestudies between median and ulnar nerve injuries

regarding sensory recovery The evaluation of touch includesperception of

touch and pressure. The two-point discrimination(2PD) is mediated by slowly-adapting nerve fibres

that indicate the perception of touch andpressure. Tactile gnosis, initially described byMoberg in 1958 as the capability of the hand torecognize the character of objects, is a primemarker of functional recovery and should be

included in any testing model.



Many factors, such a patient age, level of injury, thesize of the graft and the period between the injury and

operation, have been claimed to influence theprognosis following nerve repair.

It is accepted that nerve recovery in younger patients

is better than in older patients. Younger patients havebetter nerve regrowth and greater neural plasticity.Research patients younger than 25 years had slightlybetter results, but not significantly better. The reason

for such a results we could found in fact that we hadonly 5 patients younger than 15 years, and in 4 ofthem injury was made by glass or knife. The otherpatients mostly were with nerve reconstruction after

war injuries and extensive injuries. Those injuries



Conclusion There was not significant difference in sensory

recovery of median and ulnar nerves. The graftlength and denervation time significantlyinfluenced the functional outcome in sensory

recovery. Mechanism of injury impacted on theresults.

Better results were in the patients in which theautograft length was up to 5 cm, and in patients

who were operated within six months from theinjury.



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Sensory Recovery After Forearm

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