Donor nerve graft assessment for covering thumb nerve defects: a cadaveric study
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(2020) 15:456
RESEARCH ARTICLE
Open Access
Donor nerve graft assessment for covering thumb nerve defects: a cadaveric study Hamid Namazi1, Ahmad Sobhani1, Saeed Gholamzadeh2, Amirreza Dehghanian3 and Fatemeh Dehghani Nazhvani1*
Abstract Background: Even though several studies reported donor autologous nerve grafts for digital nerve defects, there is no report in the literature regarding acceptable graft for thumb nerves. The purpose of this study is to provide guidelines for autologous nerve graft selection by detecting similarities between thumb nerve zones and donor nerve with regard to the number of fascicles and cross-sectional area. Materials and methods: Five cadavers were used in this study. An anatomical zoning system was defined for thumb nerves (zones 1, 2, 3). Sural nerve (SN), medial antebrachial cutaneous nerve (MABCN), lateral antebrachial cutaneous nerve (LABCN), posterior interosseous nerve (PIN), and anterior interosseous nerve (AIN) were selected as donor nerve grafts. The number of fascicles and surface area (mm2) was defined. Results: The mean of the fascicle number in zone 1, zone 2, zone 3, AIN, PIN, LABCN, MABCN, and SN were 3.8, 4.7, 6.1, 2.2, 1.8, 4.5, 3.1, and 6.4, respectively. The mean of the surface area in zone 1, zone 2, zone 3, AIN, PIN, LABCN, MABCN, and SN were 2.19, 6.26, 4.04, 1.58, 0.71, 5.00, 3.01, and 8.06, respectively. Conclusions: LABCN is the best choice for all zones that has fascicular matching with all three zones of thumb nerves and caliber matching with zones 2 and 3. In zone 1, the best nerve graft is MABCN which has both suitable caliber and fascicle count. Keywords: Nerve allografts, Peripheral nerve reconstruction, Thumb nerve defect, Donor nerves, Anatomical zoning system
Introduction Untreated digital nerve injury of the thumb can lead to significant sensory impairment. In cases of nerve gap, an autologous nerve graft is considered as the gold standard to bridge defects [1, 2]. So it is crucial to assess the available donor nerves for reconstructing thumb nerve defects. Several studies reported donor autologous nerve grafts for digital nerve defects, but there is no report in the literature regarding acceptable graft for thumb nerves [3–6].
* Correspondence: [email protected]; [email protected] 1 Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Full list of author information is available at the end of the article
Thumbs have four functional muscles that are mostly motor innervated by the lateral terminal branch of the median nerve and then by the deep branch of the ulnar nerve [7]. Generally, the median nerve divides into three common palmar digital nerves, which the first one trifurcates and two of them supply the sides of the thumb. Three variations had been reported by Jolley et al. in thumb-index finger sensory innervations in 1997 [8]. Type I with a rate of 69% has a radial thumb palmar digital nerve and a common palmar digital nerve that bifurcates at the first web space and innervates the uln
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