Hosseini Helia, Diatta Fortunay, Parikh Neil, Dony Alna, Yu Catherine T, Persad-Paisley Elijah, Lu Johnny Chuieng-Yi, Hill Elspeth Jane Rose
Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT.
School of Medicine, University of Leeds, Leeds, UK.
J Hand Surg Glob Online. 2024 May 22;6(5):766-778. doi: 10.1016/j.jhsg.2024.01.028. eCollection 2024 Sep.
Vascularized nerve grafts (VNGs) have been proposed as encouraging alternatives to conventional nerve grafting; however, there is ongoing debate regarding the clinical advantages of the approach compared with standard grafting. This review aims to gather and analyze reported cases of upper extremity nerve repair using VNGs documented in the published literature.
In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed/MEDLINE, Embase, and Cochrane were searched. Inclusion criteria for this review included the following: (1) human subjects or cadaveric studies, (2) describing a vascularized nerve grafting procedure or suggesting a nerve and vascular supply for a potential vascularized nerve graft, and (3) upper extremity nerve repair in clinical studies.
Data were extracted from 45 clinical studies. Of 535 patients, the most common injury pattern was root avulsion and rupture (88.7%). The most utilized VNG was the ulnar nerve (72.8%), followed by nerve to long head of triceps (8.8%) and sural nerve (8.2%); most common recipients were median (57.6%), axillary (12.5%), and musculocutaneous nerves (11.9%). Between patients who had medical research council scale scores, 69% had functional (M3 and above) motor and 72.7% sensory (S3<) recovery.
Vascularized nerve grafts can increase the odds of functional gain in challenging conditions such as large nerve gaps, nerve avulsions, ruptures, and scarred and irradiated beds. With the exception of well-known VNG options, literature on alternative VNGs is largely confined to case reports and series, with additional published cases, outcomes, and basic science research needed to establish the role of VNGs in nerve repair.
Our findings support the promise of VNGs for complex cases of nerve reconstruction. Evidence from published cases also indicates that VNGs enhance motor and sensory function recovery compared with traditional nerve grafting.
血管化神经移植（VNG）已被提议作为传统神经移植的一种有前景的替代方法；然而，与标准移植相比，该方法的临床优势仍存在争议。本综述旨在收集和分析已发表文献中记录的使用VNG进行上肢神经修复的报告病例。
按照系统评价和Meta分析的首选报告项目指南，检索了PubMed/MEDLINE、Embase和Cochrane数据库。本综述的纳入标准包括：（1）人体受试者或尸体研究；（2）描述血管化神经移植手术或为潜在的血管化神经移植提出神经和血管供应；（3）临床研究中的上肢神经修复。
从45项临床研究中提取数据。在535例患者中，最常见的损伤模式是根部撕脱和断裂（88.7%）。最常用的VNG是尺神经（72.8%），其次是肱三头肌长头神经（8.8%）和腓肠神经（8.2%）；最常见的受区神经是正中神经（57.6%）、腋神经（12.5%）和肌皮神经（11.9%）。在有医学研究委员会量表评分的患者中，69%有功能性（M3及以上）运动恢复，72.7%有感觉（S3<）恢复。
血管化神经移植可以增加在诸如大神经缺损、神经撕脱、断裂以及瘢痕和放疗部位等具有挑战性的情况下获得功能改善的几率。除了众所周知的VNG选择外，关于替代VNG的文献大多局限于病例报告和系列研究，需要更多已发表的病例、结果和基础科学研究来确定VNG在神经修复中的作用。
我们的研究结果支持VNG在复杂神经重建病例中的前景。已发表病例的证据还表明，与传统神经移植相比，VNG可增强运动和感觉功能恢复。
