Commentary on "A new device for nerve approximation
in traumatic injuries of extremities" by K.S. Forootan et al.
Received: 26 June 2014 /Accepted: 26 June 2014 /Published online: 9 July 2014
Springer-Verlag Berlin Heidelberg 2014
The authors propose a sophisticated device working as a nerve
stump approximator and present two retrospective series out of
their huge clinical and surgical experience to share their skill
and show that good outcomes are possible .
The reader in European countries might be reluctant, as the
device is aggressive for both stumps and because tension
should be avoided in primary repair. But who does not re-
member a situation where a little gap of 1 or 2 cm made us
wonder if we should really go for a transplant or not try that
single time to coapt both stumps, once they were dissected
more proximally and distally to allow approximation. As the
authors say: if then 8 or 9/0 sutures hold the stumps together,
probably the local tension is acceptable. Graft harvesting thus
might be prevented in these cases and high fascicle density on
both sides of the approximated stumps might be the base of a
good clinical recovery.
Moreover, the authors have a large clinical experience of
nerve injuries in a geographic region where, unfortunately,
war injuries were very common in the last decades. In Europe,
World War I and II stimulated a lot of improvement in nerve
repair and their work should be considered for what it is: a
surgeon’s honest trial to improve his surgical repair and a
retrospective analysis in two clinical series how functional
results may improve.
We never see those large series of severely injured patients,
and perhaps, we will remain reluctant to fabricate or use such
an approximator. But the good results interfere with some
principles about nerve repair (tension, fiber density); we could
address in new research protocols to improve our knowledge
and perhaps think differently in selected cases.
Conflicts of Interest None
Ethical Standards This manuscript does not contain clinical studies or
1. Forootan KS, Karimi H, Forootan N-SS (2014) A new device for
nerve approximation in traumatic injuries of extremities. Eur J Plast
J. Bahm (*)
Euregio Reconstructive Microsurgery Unit, Franziskushospital,
Eur J Plast Surg (2014) 37:503