CLINICAL IMPORTANCE OF DIVIDING DISTAL COMPLETE NERVE DAMAGES OF THE UPPER EXTREMITY INTO TOPOGRAPHIC ZONES

Abstract

Objective: To show the clinical significance of dividing distal complete nerve damages of the upper extremity into topographic zones for the optimal reconstruction of the nerve at distal branching segment. Methods: Clinical material of 109 patients represented with damages of 129 nerve branches at the distal segment. Median nerves were cut in 63 cases (48.8%), ulnar nerve – 44 cases (34.1%), radial nerve – in 22 cases (17.1%). Three types of reconstruction were applied: emergency primary end to end repair – 57 nerves, secondary end to end repair 34 nerves, and autoneuroplasty – 38 nerves. Distal injuries were classified into three zones: I zone – above the segment of nerves separation of branch ends – 39 nerve trunks (30.2%), II zone – at the level of branching – 66 nerve trunks (51.2%), and III zone – more distal cut of single or multiple terminal branches – 24 nerves (18.6%). Results: Excellent and good results were obtained in 95.2% of cases after primary end to end nerve repair. Secondary end to end repair and nerve grafting showed 82-85% of good and excellent results. Conclusion: Classification developed for distal nerve damage is a tool for performing a high-quality revision of the damaged area with full identification of the damage pattern and restoration of the previous anatomy

Keywords

• nerve-injured zones
• distal damages of nerves
• upper extremity
• primary nerve repair
• secondary nerve repair
• autoneuroplasty.