Eur J Plast Surg (2003) 26:95 DOI 10.1007/s00238-003-0477-x INVITED COMMENTAR Y David Evans Comments on “End-to-side neurorrhaphy of sensory nerves” and “End-to-side neurorrhaphy of motor nerves: reinnervation of free muscle transplants – first clinical application” by Frey et al. Published online: 12 April 2003 © Springer-Verlag 2003 These two contributions represent a significant step for- not yet have been fully resolved, but the results reported ward in the application of end-to-side anastomosis to here suggest that the former is adequate, with the obvi- both sensory and motor nerve reconstruction. Of the two, ous advantage of avoiding axonal damage in the donor the most objectively irrefutable success of this technique nerve. The authors raise the risk of cocontraction if an is to be found in the reinnervation of free muscle trans- antagonist's nerve supply is used, but this would be the fers. To be able to achieve muscle function of MRC case whatever method of nerve anastomosis is employed. grade 3 or 4 through end-to-side anastomosis is progress The sensory recovery from end-to-side anastomosis is indeed and has several major advantages over standard also encouraging, although less objective. Certainly this end-to-end anastomosis, including the avoidance of any is a valuable technique when the proximal nerve has functional loss in the muscle supplied by the donor been lost, but it remains to be demonstrated whether the nerve, avoidance of long nerve grafts, and the possibility result can compare with a short nerve graft of even direct of introducing a free muscle where the proximal nerve repair. Presumably a nerve repaired in this way will be supply is missing. The question of whether epineuroto- free of the usual attendant neuroma symptoms at the site my alone or an additional perineurotomy is required may of repair. It would be interesting to know how much this affects the perceived “normality” of the sensation achieved. Lack of a symptomatic neuroma would cer- This commentary refers to contributions which can be found at http://dx.doi.org/10.1007/s00238-003-0475-z and tainly enhance a nerve reconstruction. http://dx.doi.org/10.1007/s00238-003-0476-y Both contributions outline precise situations in which end-to-side nerve repair can be applied clinically, and it D. Evans ( ) remains to be seen how its use can be extended in the Windsor, UK e-mail: email@example.com light of further results.
European Journal of Plastic Surgery – Springer Journals
Published: May 1, 2003
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