Dijital Sinir Tamir Sonuçları ve Etkileyen Faktörler

Çalışmamızın amacı dijital sinir onarımı sonrası başarının objektif olarak değerlendirilmesi ve başarıyı etkileyen faktörlerin incelenmesidir. Çalışmaya 3 yıllık bir süre içinde tedavi edilen ve kontrole gelen 51 hastadaki 73 dijital sinir onarımı retrospektif olarak dahil edilmiştir. Hastaların yaşı, cinsiyeti, mesleği, dominant eli, yaralanan dijital sinirin lokalizasyonu, yaralanma ile ameliyat arasında geçen süre, sinir yaralanmasına eşlik eden diğer el yaralanmaları, yaralanma tipi ve sigara içme alışkanlıkları kayıt edilmiştir. İyileşmenin değerlendirilmesinde birincil olarak iki nokta diskriminasyon testi kullanılmış bunun yanında monofilament, diyapazon, ten, kavrama ve çimdikleme testleri de uygulanmıştır. Çalışmamızda sinir onarımlarının %84.9’unda iki nokta diskriminasyon testine göre iyi ve çok iyi olarak değerlendirilmiştir. Monofilament testine göre %72.6 normal ve azalmış hafif dokunma olarak bulunmuştur. Diyapazon testinde pozitiflik oranı %89 iken ten testine göre hastaların %86.3’ü istenen seviyede idi. Yaş, sigara kullanımı, yaralanma tipi ve duyusal iyileşme arasında negatif bir ilişki vardı. Dijital sinir tamirleri yüksek iyileşme potansiyeli ile tatminkâr sonuçlar vermektedir. Hastanın yaşı, sigara kullanımını ve yaralanma tipi dijital sinir tamir sonuçlarını kötü olarak etkilemekle birlikte, yaş dışında kalan epidemiyolojik özellikler, ameliyatta kadar geçen süre, takip süresi, eşlik eden diğer el yaralanmaları ve yaralanmanın olduğu parmak iyileşme üzerine anlamlı bir etkiye sahip değildir.

Anahtar Kelimeler:

Dijital Sinir, İyileşme, Tamir

Digital Nerve Repair Results and Affecting Factors

The aim of this study is to evaluate the success of the digital nerve repair and to examine the factors affecting recovery. Seventy-three digital nerve repairs in 51 patients who were treated over a 3-year period were retrospectively included in the study. Patients' age, gender, profession, dominant hand, localization of the injured digital nerve, the time between injury and surgery, other hand injuries accompanying nerve injury, injury type and smoking habits were recorded. In the evaluation of the nerve recovery, two point discrimination test was used primarily, besides monoflament, tuning fork, skin, grip and pinch tests were also applied. In this study, 84.9% of nerve repairs were evaluated as good and very good according to the two-point discrimination test. According to the monoflament test, 72.6% was normal and decreased light touch. The positivity rate in the tuning fork test was 89% and according to the skin test, 86.3% of the patients were at the desired level. There was a negative relationship between age, smoking, injury type, and sensory recovery. Digital nerve repairs provide satisfactory results with high healing potential. Patient age, smoking, and type of injury negatively affect digital nerve repair results. Epidemiological features other than age, time to surgery, follow-up time and other accompanying hand injuries do not have a significant effect on healing.

Keywords:

Digital Nerve, Recovery, Repair,

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1. Lohmeyer JA, Sommer B, Siemers F, Mailänder P. Nerve injuries of the upper extremity-expected outcome and clinical examination. Plast Surg Nurs. 2009;29(2):88-93.
2. Herndon JH. Neuromas. In: Green DP. Green’s Operative Hand Surgery. 1988; 1405-1423. 4th Ed. New York: Churcill-Livingstone.
3. Pedretti LW, Early MB. Occupational therapy practice skills for physical dysfunction, 5th Ed. St. Louis: Mosby, 2001.
4. Efstathopoulos D, Gerostathopoulos N, Misitzis D, Bouchlis G, Anagnostou S, Daoutis NK. Clinical assessment of primary digital nerve repair. Acta Orthop Scand Suppl. 1995;264(23):45–7.
5. Bulut T, Akgun U, Ozcan C, Unver B, Sener M. Inter- and intra-tester reliability of sensibility testing in digital nerve repair. J Hand Surg Eur Vol. 2016;41(6):621-3.
6. Young L, Wray RC, Weeks PM. A randomized prospective comparison of fascicular and epineural digital nerve repairs. Plast Reconstr Surg. 1981;68(1):89-93.
7. Calcagnotto GN, Braga Silva J. The treatment of digital nerve defects by the technique of vein conduit with nerve segment. A randomized prospective study. Chir Main. 2006;25(3-4):126-30.
8. Wang WZ, Crain GM, Baylis W, Tsai TM. Outcome of digital nerve injuries in adults. J Hand Surg Am. 1996;21(1):138-43.
9. Weinzweig N, Chin G, Mead M, et al. Recovery of sensibility after digital neurorrhaphy: a clinical investigation of prognostic factors. Ann Plast Surg. 2000;44(6):610-7.
10. Cheng AS, Hung L, Wong JM, Lau H, Chan J. A prospective study of early tactile stimulation after digital nerve repair. Clin Orthop Relat Res. 2001;(384):169-75.
11. Kallio PK. The results of secondary repair of 254 digital nerves.J Hand Surg Br. 1993;18(3):327-30.
12. Dellon AL, Mackinnon SE, Crosby PM. Reliability of two-point discrimination measurements. J Hand Surg Am. 1987;12(5):693-6.
13. Mailänder P, Berger A, Schaller E, Ruhe K. Results of primary nerve repair in the upper extremity. Microsurgery. 1989;10(2):147-50.
14. Novak CB, Mackinnon SE, Kelly L. Correlation of two-point discrimination and hand function following median nerve injury. Ann Plast Surg. 1993;31(6):495-8.
15. Efstathopoulos D, Gerostathopoulos N, Misitzis D, Bouchlis G, Anagnostou S, Daoutis NK. Clinical assessment of primary digital nerve repair. Acta Orthop Scand Suppl. 1995;264:45-7.
16. Altissimi M, Mancini GB, Azzarà A. Results of primary repair of digital nerves. J Hand Surg Br. 1991;16(5):546-7.
17. Chaise F, Friol JP, Gaisne E. Results of emergency repair of wounds of palmar collateral nerves of the fingers. Rev Chir Orthop Reparatrice Appar Mot. 1993;79(5):393-7.
18. Risitano G, Cavallaro G, Merrino T, Coppolino S, Ruggeri F. Clinical results and thoughts on sensory nerve repair by autologous vein graft in emergency hand reconstruction. Chir Main. 2002;21(3):194-7.
19. Sullivan DJ. Results of digital neurorrhaphy in adults. J Hand Surg Br. 1985;10(1):41-4.
20. Mermans JF, Franssen BB, Serroyen J, Van der Hulst RR. Digital nerve injuries: a review of predictors of sensory recovery after microsurgical digital nerve repair. Hand (N Y). 2012;7(3):233-41.
21. al-Ghazal SK, McKiernan M, Khan K, McCann J. Results of clinical assessment after primary digital nerve repair. J Hand Surg Br. 1994;19(2):255-7.
22. Berger A, Millesi H. Nerve Grafting. Clin Orthop Relat Res. 1978;(133):49-55.
23. Rinker B, Liau JY. A prospective randomized study comparing woven polyglycolic acid and autogenous vein conduits for reconstruction of digital nerve gaps. J Hand Surg Am. 2011;36(5):775-81.
24. Portincasa A, Gozzo G, Parisi D, et al. Microsurgical treatment of injury to peripheral nerves in upper and lower limbs: a critical review of the last 8 years. Microsurgery. 2007;27(5):455-62.
25. Rinker B, Fink BF, Barry NG, et al. The effect of cigarette smoking on functional recovery following peripheral nerve ischemia/reperfusion injury. Microsurgery. 2011;31(1):59-65.
26. Segalman KA, Cook PA, Wang BH, Theisen L. Digital neurorrhaphy after the age of 60 years. J Reconstr Microsurg. 2001;17(2):85-8.
27. Seddon H. Surgical Disorders of Peripheral Nerve. 2nd Ed. London: Churchill Livingstones, 1975.
28. Birch R. Primary and Secondary Repair of Divided Peripheral Nerves. Smith Operative Surgery; The Hand .4th Ed. London: Butterworhts, 1984.
29. Weber RA, Breidenbach WC, Brown RE, Jabaley ME, Mass DP. A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans. Plast Reconstr Surg. 2000;106(5):1036-45.
30. Walton RL, Brown RE, Matory WE Jr, Borah GL, Dolph JL. Autogenous vein graft repair of digital nerve defects in the finger: a retrospective clinical study. Plast Reconstr Surg. 1989;84(6):944-52.