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Vascularized Cable Nerve Graft to Restore 10cm Nerve Gap
Lundrim Marku, MS2
Joshua T. Henderson, MD
Luis H. Quiroga, MD, MPH
Jack Gelman, MD , FACS
West Virginia University School of Medicine
2022-01-14
Presenter: Lundrim Marku
Affidavit:
To whom It may concern:
This research has not been published elsewhere and not presented at a major meeting.
Kerri M. Woodberry, MD, MBA, FACS
Division Chief
Plastic and Reconstructive Surgery/
Hand Surgery
Residency Program Director
Associate Professor
WVU Medicine
One Medical Center Drive
PO Box 9238
Morgantown, WV 26506-9238
Phone 304-293-3311
Fax 304-293-2556
kerri.woodberry@hsc.wvu.edu
Director Name: Kerri M. Woodberry, MD, MBA, FACS
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Introduction:
Proximal nerve injuries in the upper extremity are subject to few reconstructive options to yield a functional result. While interposition nerve grafting is commonly employed for defects greater than 3cm, proximal defects and larger nerve gaps require alternative solutions. In the case of high radial nerve palsy or injury, gaps of 6cm or greater are typically addressed with tendon transfers. Vascularized nerve grafts have been proposed for these defects but have yet not been described as cable grafts.
Methods:
A right-hand dominant man required repeat resection of a recurrent left upper extremity myofibroblastic tumor, resulting in the sacrifice of a 10-cm segment of the radial nerve. A vascularized sural nerve graft was harvested, fascicles separated and interposed as a cable nerve graft, and accompanying lesser saphenous vein anastomosed in an arteriovenous loop construct.
Results:
Recurrence of the myofibroblastic tumor required glenohumeral amputation at three months following the nerve graft. At that time, the dorsal forearm sensation was markedly improved, but motor function had not yet returned. Upon amputation, the vascularized nerve graft was sectioned at 1cm intervals for histologic analysis. Nerve caliber was thinned and exhibited fewer nerve bundles towards the distal coaptation, but the perineurium remained intact surrounding viable nerve fascicles.
Conclusion:
To our knowledge, this is the first report of a vascularized cable nerve graft. This is a novel technique to address complex peripheral nerve reconstruction. We present histologic and clinical evidence of nerve viability with potential for expedient functional recovery in a high radial nerve defect.
