RESEARCH ARTICLE


Advances of Peripheral Nerve Repair Techniques to Improve Hand Function: A Systematic Review of Literature



Mafi P1, Hindocha S*, 2, 3, Dhital M4, Saleh M5
1 Hull York Medical School, John Hughlings Jackson Building, University of York, Heslington, York, YO10 5DD, UK
2 Manchester Interdisciplinary Biocentre, University of Manchester, 131 Princess Street, M17DN, UK
3 Department of Plastic Surgery, Whiston General Hospital, Liverpool, L355DR, UK
4 University of Nottingham, University Park, Nottingham, NG7 2RD. UK
5 Shams University, Khalifa El-Maamon St, Abbasiya Sq, Cairo. 11566. Egypt


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Creative Commons License
© Mafi et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Plastic Surgery, Whiston Hospital, Warrington Road, L355DR, UK; Tel: 01244366265; Fax: 01244366265; E-mail: hindocha2001@yahoo.com


Abstract

Concepts of neuronal damage and repair date back to ancient times. The research in this topic has been growing ever since and numerous nerve repair techniques have evolved throughout the years. Due to our greater understanding of nerve injuries and repair we now distinguish between central and peripheral nervous system. In this review, we have chosen to concentrate on peripheral nerve injuries and in particular those involving the hand. There are no reviews bringing together and summarizing the latest research evidence concerning the most up-to-date techniques used to improve hand function. Therefore, by identifying and evaluating all the published literature in this field, we have summarized all the available information about the advances in peripheral nerve techniques used to improve hand function. The most important ones are the use of resorbable poly[(R)-3-hydroxybutyrate] (PHB), epineural end-to-end suturing, graft repair, nerve transfer, side to side neurorrhaphy and end to side neurorrhaphy between median, radial and ulnar nerves, nerve transplant, nerve repair, external neurolysis and epineural sutures, adjacent neurotization without nerve suturing, Agee endoscopic operation, tourniquet induced anesthesia, toe transfer and meticulous intrinsic repair, free auto nerve grafting, use of distal based neurocutaneous flaps and tubulization. At the same time we found that the patient’s age, tension of repair, time of repair, level of injury and scar formation following surgery affect the prognosis. Despite the thorough findings of this systematic review we suggest that further research in this field is needed.

Keywords: Advances of nerve technique, hand function, neural regeneration, nerve repair techniques, peripheral nerve injury, peripheral nerve repair.