Diagnosis and Treatment in Peripheral Nerve Surgery

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Methodology, Drug and Device Discovery".

Deadline for manuscript submissions: closed (1 August 2023) | Viewed by 13732

Image courtesy of Cover illustration: Aron Cserveny – Science Visual

Special Issue Editors


E-Mail Website1 Website2
Guest Editor
1. Department for Plastic Aesthetic and Reconstructive Surgery, The St Poelten University Hospital, Vienna, Austria
2. Clinical Laboratory for Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
Interests: clinical and basic science studies on handsurgery; plastic and reconstructive surgery with a special focus on nerve reconstruction and regeneration

E-Mail Website
Co-Guest Editor
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany
Interests: peripheral nerve surgery; traumatic nerve injuries; surgery oft he spastic hand; surgery oft he tetraplegic hand; facial palsy reconstruction; congenital hand surgery; general hand surgery; orthopaedic plastic surgery

Special Issue Information

Dear Colleagues,

Background: Nerve lesions and pain and compression syndromes are often difficult to diagnose and treat due to the broad spectrum of pathologies and the high degree of specialization being required for optimal treatment. In line with this, the diagnosis and treatment of this spectrum remains an exciting multidisciplinary topic in both neuroscience and reconstructive surgery.

Aim and Scope: We aim to publish articles describing novel personalized medicine approaches for the diagnosis and treatment of peripheral nerve lesions and nerve-related pain and compression syndromes.

History: Peripheral nerve surgery has been conducted for over a century, but the problem of correctly diagnosing the type of nerve lesion as well as overcoming slow nerve regeneration remains. Many novel techniques such as nerve transfers have been developed to solve these problems. Likewise, modern imaging methods such as high-resolution nerve sonography and MR-neurography have revolutionized the diagnosis of nerve pathologies.

Cutting-Edge Research: Peripheral nerve research has expanded to groundbreaking basic science studies, novel technologies, genetic studies, and new surgical techniques.

What kinds of papers we are soliciting: We encourage the submission of basic science, translational science and clinical studies regarding peripheral nerve lesions and nerve-related pain and compression syndromes. Exciting case studies or series may also be published if they include a comprehensive review of the literature.

Dr. Konstantin Bergmeister
Prof. Dr. Leila Harhaus
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • peripheral nerve
  • nerve surgery
  • neuroma
  • peripheral nerve regeneration
  • reconstructive surgery
  • neurotomy
  • nerve
  • nerve gap
  • nerve tubes
  • peripheral nerve imaging
  • nerve sonography
  • neurosonography
  • nerve pain

Published Papers (9 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Other

11 pages, 1806 KiB  
Article
Effect of Metformin on the Functional and Electrophysiological Recovery of Crush Injury-Induced Facial Nerve Paralysis in Diabetic Rats
by Kyung Hoon Sun, Cheol Hee Choi, Gwang-Won Cho and Chul Ho Jang
J. Pers. Med. 2023, 13(9), 1317; https://doi.org/10.3390/jpm13091317 - 27 Aug 2023
Cited by 1 | Viewed by 986
Abstract
The impact of metformin on the rat facial nerve following crush injury has only occasionally been documented to date. The purpose of the current investigation was to use functional and electrophysiological evaluations to investigate the effects of metformin administration on recovery following crush [...] Read more.
The impact of metformin on the rat facial nerve following crush injury has only occasionally been documented to date. The purpose of the current investigation was to use functional and electrophysiological evaluations to investigate the effects of metformin administration on recovery following crush injury to the rat facial nerve. The rats were randomly divided into four groups: the nonDM/PBS group (n = 4), the nonDM/metformin group (n = 4), the DM/PBS group (n = 4), and the DM/metformin group (n = 4). Diabetes was generated by an intraperitoneal injection of streptozotocin. Facial nerve paralysis was induced by a crush injury 7 days after diabetes induction. The blood glucose levels of the DM/PBS and DM/metformin groups were maintained at over 300 mg/dL, whereas the blood glucose levels of the nonDM/PBS and nonDM/metformin groups were maintained at less than 150 mg/dL. There was no significant difference between the two nonDM groups. In comparison to the PBS group, the metformin group’s recurrence of vibrissa fibrillation occurred noticeably sooner over time. The nonDM/metformin group showed the highest recovery rate in the second, third, and fourth weeks post-crush, respectively. The threshold of action potential 4 weeks after crush injury showed that the nonDM/metformin group had a significantly lower mean threshold of MAP compared to other groups. The short-term effect of metformin on the recovery of facial nerve blood flow (FNBF) was significantly increased compared to the DM/PBS group. However, there was no significant difference in FNBF between the nonDM/metformin and nonDM/PBS groups. A diabetic condition promoted a delay in FN regeneration. Metformin is able to accelerate functional recovery in diabetic or nondiabetic FN-injured rats. Further studies using a morphometric or molecular approach are planned to understand the pharmacologic mechanism of metformin. Full article
(This article belongs to the Special Issue Diagnosis and Treatment in Peripheral Nerve Surgery)
Show Figures

Figure 1

10 pages, 738 KiB  
Article
Nerve Transfers for Brachial Plexus Reconstruction in Patients over 60 Years
by Andreas Gohritz, Gregor Laengle, Anna Boesendorfer, Bernhard Gesslbauer, Clemens Gstoettner, Olga Politikou, Agnes Sturma and Oskar C. Aszmann
J. Pers. Med. 2023, 13(4), 659; https://doi.org/10.3390/jpm13040659 - 12 Apr 2023
Viewed by 1729
Abstract
Negative expectations regarding nerve reconstruction in the elderly prevail in the literature, but little is known about the effectiveness of nerve transfers in patients with brachial plexus injuries aged over 60 years. We present a series of five patients (1 female, 4 male) [...] Read more.
Negative expectations regarding nerve reconstruction in the elderly prevail in the literature, but little is known about the effectiveness of nerve transfers in patients with brachial plexus injuries aged over 60 years. We present a series of five patients (1 female, 4 male) aged between 60 and 81 years (median 62.0 years) who underwent nerve reconstruction using multiple nerve transfers in brachial plexopathies. The etiology of brachial plexus injury was trauma (n = 2), or iatrogenic, secondary to spinal surgical laminectomy, tumor excision and radiation for breast cancer (n = 3). All but one patient underwent a one-stage reconstruction including neurolysis and extra-anatomical nerve transfer alone (n = 2) or combined with anatomical reconstruction by sural nerve grafts (n = 2). One patient underwent a two-stage reconstruction, which involved a first stage anatomical brachial plexus reconstruction followed by a second stage nerve transfer. Neurotizations were performed as double (n = 3), triple (n = 1) or quadruple (n = 1) nerve or fascicular transfers. Overall, at least one year postoperatively, successful results, characterized by a muscle strength of M3 or more, were restored in all cases, two patients even achieving M4 grading in the elbow flexion. This patient series challenges the widely held dogma that brachial plexus reconstruction in older patients will produce poor outcomes. Distal nerve transfers are advantageous as they shorten the reinnervation distance. Healthy, more elderly patients should be judiciously offered the whole spectrum of reconstructive methods and postoperative rehabilitation concepts to regain useful arm and hand function and thus preserve independence after a traumatic or nontraumatic brachial plexus injury. Full article
(This article belongs to the Special Issue Diagnosis and Treatment in Peripheral Nerve Surgery)
Show Figures

Figure 1

11 pages, 2251 KiB  
Article
Early Postoperative Recovery after Modified Ultra-Minimally Invasive Sonography-Guided Thread Carpal Tunnel Release
by Konrad Mende, Saskia J. M. Kamphuis, Valentin Schmid, Dirk J. Schaefer, Alexandre Kaempfen and Andreas Gohritz
J. Pers. Med. 2023, 13(4), 610; https://doi.org/10.3390/jpm13040610 - 31 Mar 2023
Cited by 3 | Viewed by 1503
Abstract
Thread carpal tunnel release (TCTR) has been reported to be safe and effective for the treatment of carpal tunnel syndrome. The aim of this study is to evaluate the modified TCTR for safety, efficacy, and postoperative recovery. Seventy-six extremities in 67 patients undergoing [...] Read more.
Thread carpal tunnel release (TCTR) has been reported to be safe and effective for the treatment of carpal tunnel syndrome. The aim of this study is to evaluate the modified TCTR for safety, efficacy, and postoperative recovery. Seventy-six extremities in 67 patients undergoing TCTR were analyzed pre- and postoperatively using clinical parameters and patient-reported outcome measures. Twenty-nine men and 38 women with a mean age of 59.9 ± 18.9 years underwent TCTR. The mean postoperative time to resume activities of daily living was 5.5 ± 5.5 days, analgesia was completed after 3.7 ± 4.6 days, and return to work was achieved after a mean of 32.6 ± 15.6 days for blue-collar workers and 4.6 ± 4.3 days for white-collar workers. The Boston Carpal Tunnel Questionnaire (BCTQ) and Disability of Arm, Shoulder, and Hand (DASH) scores were comparable with previous studies. Overall, two persistent compressions and one recurrence required open reoperation (3.9%). All three had been operated in the initial phase, and none required reoperation after an additional safety step was introduced. No other complications occurred. TCTR surgery appears to be a safe and reliable technique with almost no wound and scarring and a potentially faster recovery time than open techniques. Although our technical modifications may reduce the risk of incomplete release, TCTR requires both ultrasound and surgical skills and has a considerable learning curve. Full article
(This article belongs to the Special Issue Diagnosis and Treatment in Peripheral Nerve Surgery)
Show Figures

Figure 1

10 pages, 2015 KiB  
Article
The Usefulness of Motor Potentials Evoked Transvertebrally at Lumbar Levels for the Evaluation of Peroneal Nerve Regeneration after Experimental Repair in Rats
by Piotr Czarnecki, Juliusz Huber, Agnieszka Szukała, Michał Górecki and Leszek Romanowski
J. Pers. Med. 2023, 13(3), 438; https://doi.org/10.3390/jpm13030438 - 28 Feb 2023
Cited by 3 | Viewed by 1007
Abstract
Motor evoked potentials (MEPs) are used in neurology as part of a precise diagnostic method to study the transmission of efferent neural impulses at the central and peripheral levels of the nervous system. Previous attempts have been made to apply MEPs in animal [...] Read more.
Motor evoked potentials (MEPs) are used in neurology as part of a precise diagnostic method to study the transmission of efferent neural impulses at the central and peripheral levels of the nervous system. Previous attempts have been made to apply MEPs in animal studies for evaluating neural transmission at the motor cortex center level to the muscles of the forelimbs and hindlimbs. In clinical and experimental studies, little attention is focused on the significance of the magnetic stimulation of spinal cord structures with the direct recording of the evoked potentials from peripheral nerve motor fibers. The aim of this paper was to evaluate the usefulness of the motor potentials evoked transvertebrally at lumbar levels in the evaluation of experimental peroneal nerve regeneration in rats. The bilateral transmission of efferent impulses in the distal parts of the peroneal and tibial nerves was verified by recordings of evoked potentials following transvertebral magnetic stimulation at lumbar levels (MEPs) and the electrical stimulation of the sciatic nerve in classical electroneurographic (ENG) tests for comparison. Recordings were performed 24 weeks after grafts on surgically treated hindlimbs as well as on non-operated hindlimbs as controls. Both the MEP and ENG stimulations resulted in evoked potentials with larger amplitude values following the application of the magnetic pulses, with more being recorded on the non-operated hindlimbs than on the operated ones when recordings were taken from peroneal nerve branches. We observed statistically significant correlations between the MEP and ENG results for peroneal and tibial nerve amplitude on the non-operated side and peroneal nerve amplitude on the operated side. The recorded latencies of the evoked potentials were shorter in the ENG studies than in the MEPs for the non-operated side. The results demonstrated the phenomenon of regeneration in the motor fibers of the peroneal nerves 24 weeks after grafting in the experimental conditions. In this study, the MEPs were as useful as the ENG studies for evaluating regeneration in the motor fibers of hindlimb nerves in rats, although they were not significantly different. This paper discusses the clinical importance of transvertebral MEPs induced at the lumbosacral and cervical levels with a magnetic field for the diagnostic evaluation of efferent impulse transmission at different levels of the motor pathway. Full article
(This article belongs to the Special Issue Diagnosis and Treatment in Peripheral Nerve Surgery)
Show Figures

Figure 1

9 pages, 3489 KiB  
Article
Relevance of Costovertebral Exarticulation of the First Rib in Neurogenic Thoracic Outlet Syndrome: A Retrospective Clinical Study
by Franz Lassner, Michael Becker and Andreas Prescher
J. Pers. Med. 2023, 13(1), 144; https://doi.org/10.3390/jpm13010144 - 11 Jan 2023
Cited by 3 | Viewed by 1632
Abstract
Purpose: The failure rate for operative decompression in neurogenic thoracic outlet syndrome (NTOS) is high compared to more distal nerve compression syndromes, such as cubital or carpal tunnel syndrome. Herein, we aimed to determine if a more radical approach, namely costovertebral exarticulation of [...] Read more.
Purpose: The failure rate for operative decompression in neurogenic thoracic outlet syndrome (NTOS) is high compared to more distal nerve compression syndromes, such as cubital or carpal tunnel syndrome. Herein, we aimed to determine if a more radical approach, namely costovertebral exarticulation of the first rib, may improve the postoperative results in patients with NTOS. Methods: From October 2002 to December 2020, 105 operative decompressions in 95 patients were evaluated; in 10 cases, decompressions were performed bilaterally. We presented the clinical outcomes of 59 exarticulations compared to those of 46 conventional resections. Evaluation was performed at a minimum of one year post-operation using the DASH questionnaire. Results: The exarticulation group presented with significantly better clinical outcomes (two-sample t-test assuming unequal variances, p < 0.001). Conclusions: This study showed that significantly better results were obtained when exarticulation of the first rib was performed in patients with NTOS. This finding supports the hypothesis that, in certain cases, the proximal portion of the first rib plays a pivotal role in the pathogenesis of NTOS. Full article
(This article belongs to the Special Issue Diagnosis and Treatment in Peripheral Nerve Surgery)
Show Figures

Figure 1

14 pages, 2277 KiB  
Article
An Epidemiological and Etiological Analysis of 5026 Peripheral Nerve Lesions from a European Level I Trauma Center
by Martin Aman, Kim S. Zimmermann, Mirjam Thielen, Benjamin Thomas, Simeon Daeschler, Arne H. Boecker, Annette Stolle, Amir K. Bigdeli, Ulrich Kneser and Leila Harhaus
J. Pers. Med. 2022, 12(10), 1673; https://doi.org/10.3390/jpm12101673 - 08 Oct 2022
Cited by 13 | Viewed by 1347
Abstract
Background: Peripheral nerve lesions are associated with debilitating long-term consequences. Albeit being essential for evidence-based clinical decision making, epidemiological and etiological data are scarce. We therefore aimed to comprehensively analyze epidemiological and etiological factors of peripheral nerve lesions in one of the largest [...] Read more.
Background: Peripheral nerve lesions are associated with debilitating long-term consequences. Albeit being essential for evidence-based clinical decision making, epidemiological and etiological data are scarce. We therefore aimed to comprehensively analyze epidemiological and etiological factors of peripheral nerve lesions in one of the largest cohorts. Methods: We screened a total of 110,667 patients treated at our level I trauma center between January 2012 and July 2020 for nerve lesions. Subsequently, demographics, etiologies, concomitant injuries, and lesion characteristics were analyzed. Results: A total of 5026 patients, predominantly young males suffering from non-work-related nerve injuries, were treated. Proximal levels of injury were more likely to be accompanied by fractures, whereas more distal injuries with concomitant vessel or tendon injury. Main causes were 54.6% lacerations. Acute traumatic nerve injury was treated within 24 h in 55.9% of cases. Conclusions: Given the young age of affected patients, early diagnosis and treatment in specialized centers may facilitate their early return to work and improve long-term functional outcomes. The data show the importance of a special attention on nerve injuries, which may be masked by large accompanying injuries. New findings on lesion characteristics of selected subgroups and accompanying circumstances can support a change in treatment strategies. Full article
(This article belongs to the Special Issue Diagnosis and Treatment in Peripheral Nerve Surgery)
Show Figures

Figure 1

10 pages, 1220 KiB  
Article
Muscle-in-Vein Conduits for the Treatment of Symptomatic Neuroma of Sensory Digital Nerves
by Ines Ana Ederer, Jonas Kolbenschlag, Adrien Daigeler and Theodora Wahler
J. Pers. Med. 2022, 12(9), 1514; https://doi.org/10.3390/jpm12091514 - 15 Sep 2022
Cited by 2 | Viewed by 1508
Abstract
Background: Considering the debilitating burden of neuroma resulting in a significant loss of function and excruciating pain, the use of muscle-in-vein conduits (MVCs) for the reconstruction of painful neuroma of sensory nerves of the fingers was assessed. Methods: We retrospectively analyzed 10 patients [...] Read more.
Background: Considering the debilitating burden of neuroma resulting in a significant loss of function and excruciating pain, the use of muscle-in-vein conduits (MVCs) for the reconstruction of painful neuroma of sensory nerves of the fingers was assessed. Methods: We retrospectively analyzed 10 patients who underwent secondary digital nerve repair by MVCs. The recovery of sensibility was evaluated by static and moving two-point discrimination (2PDs, 2PDm) and Semmes-Weinstein monofilament testing (SWM). The minimum follow-up was set 12 months after the operation. Results: The median period between trauma and nerve repair was 13.4 weeks (IQR 53.5). After neuroma resection, defects ranged from 10–35 mm (mean 17.7 mm, SD 0.75). The successful recovery of sensibility was achieved in 90% of patients after a median follow-up of 27.0 months (IQR 31.00). The mean 2PDs and 2PDm was 8.1 mm (SD 3.52) and 5.2 mm (SD 2.27), respectively. Assessment by SWM resulted in a mean value of 3.54 (SD 0.69). Reduction in pain was achieved among all patients; eight patients reported the complete relief of neuropathic pain. There was no recurrence of neuroma in any patient. Conclusions: Muscle-in-vein conduits provide an effective treatment for painful neuroma of digital nerves, resulting in satisfactory restoration of sensory function and relief of pain. Full article
(This article belongs to the Special Issue Diagnosis and Treatment in Peripheral Nerve Surgery)
Show Figures

Figure 1

Other

Jump to: Research

8 pages, 1391 KiB  
Case Report
Acute Foot Drop Caused by Intraneural Ganglion Cyst of the Peroneal Nerve: Literature Review and Case Report
by Giuseppe della Vecchia, Alfonso Baldi, Maria Beatrice Passavanti, Angela Lucariello, Antonio De Luca and Paolo De Blasiis
J. Pers. Med. 2023, 13(7), 1137; https://doi.org/10.3390/jpm13071137 - 14 Jul 2023
Cited by 1 | Viewed by 1488
Abstract
Background: Foot drop (FD) is characterized by an inability to lift the foot against gravity because of dorsiflexor muscle weakness. The aim of the present study is to report a clinical case of acute non-traumatic FD in patients with peroneal intraneural ganglion, after [...] Read more.
Background: Foot drop (FD) is characterized by an inability to lift the foot against gravity because of dorsiflexor muscle weakness. The aim of the present study is to report a clinical case of acute non-traumatic FD in patients with peroneal intraneural ganglion, after performing a scoping review on the methodological management of this disease. Methods: We performed a review of the literature and reported the case of a 49-year-old man with acute FD caused by an intraneural ganglion cyst of the peroneal nerve. Results: Out of a total of 201 articles, 3 were suitable for our review beyond our case report. The acute FD caused by peroneal intraneural ganglion can be managed by a careful clinical–instrumental differential diagnosis. A targeted surgery with subsequent rehabilitation produced a satisfactory motor recovery. Conclusions: Acute FD requires an appropriate diagnostic–therapeutic framework to identify and effectively treat the causes in order to promote complete recovery Full article
(This article belongs to the Special Issue Diagnosis and Treatment in Peripheral Nerve Surgery)
Show Figures

Figure 1

8 pages, 6256 KiB  
Perspective
Hopeless Neuroma—The Neurotized Free Flap Tissue Augmentation as Salvage Therapy—A Concept and Clinical Demonstration
by Martin Aman, Julia J. Glaser, Arne H. Boecker, Mirjam Thielen, Amr Eisa, Amir K. Bigdeli, Emre Gazyakan, Ulrich Kneser and Leila Harhaus
J. Pers. Med. 2023, 13(2), 313; https://doi.org/10.3390/jpm13020313 - 10 Feb 2023
Cited by 1 | Viewed by 1126
Abstract
Therapy-resistant neuroma pain is a devastating condition for patients and surgeons. Although various methods are described to surgically deal with neuromas, some discontinuity and stump neuroma therapies have anatomical limitations. It is widely known that a neurotizable target for axon ingrowth is beneficial [...] Read more.
Therapy-resistant neuroma pain is a devastating condition for patients and surgeons. Although various methods are described to surgically deal with neuromas, some discontinuity and stump neuroma therapies have anatomical limitations. It is widely known that a neurotizable target for axon ingrowth is beneficial for dealing with neuromas. The nerve needs “something to do”. Furthermore, sufficient soft tissue coverage plays a major role in sufficient neuroma therapy. We aimed, therefore, to demonstrate our approach for therapy of resistant neuromas with insufficient tissue coverage using free flaps, which are sensory neurotized via anatomical constant branches. The central idea is to provide a new target, a new “to do” for the painful mislead axons, as well as an augmentation of deficient soft tissues. As indication is key, we furthermore demonstrate clinical cases and common neurotizable workhorse flaps. Full article
(This article belongs to the Special Issue Diagnosis and Treatment in Peripheral Nerve Surgery)
Show Figures

Figure 1

Back to TopTop