Department of Hand and Peripheral Nerve Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, United Kingdom; Hands Plastics and Peripheral Nerve (HaPPeN) Research Group, United Kingdom.
Hands Plastics and Peripheral Nerve (HaPPeN) Research Group, United Kingdom; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, the Netherlands.
J Plast Reconstr Aesthet Surg. 2023 Oct;85:523-533. doi: 10.1016/j.bjps.2023.04.054. Epub 2023 Apr 20.
We aimed to explore the effectiveness of nerve transfer as an intervention to restore neurological deficits caused by extremity tumors through direct nerve involvement, neural compression, or as a consequence of oncological surgery.
A retrospective cohort study of consecutive cases was conducted, including all patients who underwent nerve transfers to restore functional deficits in limbs following soft tissue tumor resection. The threshold for a successful nerve transfer was a BMRC motor grade of 4/5 and sensory grade of 3-3+/4 with protective sensation.
In total, 29 nerve transfers (25 motor and 4 sensory) were completed in 11 patients, aged 12-70 years at referral, over a 6-year period to 2020. This included 22 upper limb and 3 lower limb motor nerve transfers. The timing of delayed nerve transfer reconstructions was 1-15 months following primary oncological resection, with immediate simultaneous reconstructions performed in 4 cases. The threshold for success was achieved in 82% of upper limb and 33% of lower limb motor nerve transfers, while all sensory transfers were successful in restoring protective sensation.
Nerve transfer surgery, a well-established technique in restoring deficits following traumatic nerve injury, is further demonstrably relevant in extremity oncological reconstruction, especially as it can be performed remotely to the tumor location or resection site and introduces a healthy nerve or fascicle to rapidly reinnervate distal muscles without sacrificing major function. This study further illustrates the importance of early recognition and referral to specialist services where multi-disciplinary surgical resection and reconstructive planning can be conducted.
IV Clinical Case Series.
我们旨在探索神经转移作为一种干预手段的有效性，以通过直接神经介入、神经压迫或作为肿瘤手术的结果来恢复因肢体肿瘤引起的神经功能缺损。
对连续病例进行了回顾性队列研究，包括所有因软组织肿瘤切除后肢体功能缺陷而行神经转移的患者。神经转移成功的标准是 BMRC 运动分级为 4/5，感觉分级为 3-3+/4，具有保护感觉。
在 6 年的时间里（2014 年至 2020 年），共有 11 名年龄在 12-70 岁的患者完成了 29 例神经转移（25 例运动神经转移和 4 例感觉神经转移）。其中包括 22 例上肢和 3 例下肢运动神经转移。延迟神经转移重建的时间为初次肿瘤切除后 1-15 个月，其中 4 例立即同时进行重建。上肢运动神经转移成功率为 82%，下肢运动神经转移成功率为 33%，而所有感觉神经转移均成功恢复了保护感觉。
神经转移手术是一种在创伤性神经损伤后恢复功能的成熟技术，在肢体肿瘤重建中进一步证明是相关的，特别是因为它可以在远离肿瘤位置或切除部位进行，并且可以引入健康的神经或束来快速重新支配远端肌肉，而不会牺牲主要功能。本研究进一步说明了早期识别和转介到多学科手术切除和重建计划可以进行的专科服务的重要性。
IV 临床病例系列。
