TUBULAR VERSUS CONVENTIONAL REPAIR OF MEDIAN AND ULNAR NERVES IN THE HUMAN FOREARM - EARLY RESULTS FROM A PROSPECTIVE, RANDOMIZED, CLINICAL-STUDY

Injury to a peripheral nerve is followed by local synthesis and releas e of neurotrophic factors of importance for the regeneration process. This concept was adopted for repair of transected human median and uln ar nerves in the forearm. As an alternative to conventional microsurgi cal repair of the nerve trunk, silicone tubes of appropriate size were used to enclose the injury zone, intentionally leaving a gap measurin g 34, mm between the nerve ends inside the tube. The early results fro m a prospective, randomized, clinical study comparing this principle w ith conventional microsurgical technique for repair of human median an d ulnar nerves, is presented. Eighteen patients (14 men and 4 women), aged 12-72 (mean, 29.5) years, were randomized to either tubulization (11 cases) or conventional microsurgical repair (7 cases). A battery o f rests for sensory and motor functions of the hand were carried out a t regular intervals for up to 1 year after surgery. The results show n o difference between the both techniques, with the exception of percep tion of touch, which showed a significant difference (p < .05) at the 3-month checkup in favor of the tubulization technique. At re-explorat ion 11: months after the initial procedure (1 case), the former gap wa s replaced by regenerated nerve tissue in direct continuity with the p roximal and distal parts of the nerve trunk, the exact level of the fo rmer injury being impossible to identify. Study data demonstrate an in trinsic capacity of human major nerve trunks to reconstruct themselves in a preformed space when an optimal environment is offered and the s urgical trauma is minimized.