Poor results after nerve grafting in the upper extremity: Quo vadis?

Abstract

The clinical success of peripheral nerve grafting in the upper extremity was evaluated retrospectively in 41 patients. This study comprises a 10-year follow-up in a single institution. Donor and acceptor site morbidity as well as functional nerve recovery were evaluated. Thirty-one men and 10 women were included. Autologous nerve grafts were used for reconstruction of digital nerves in 17 patients, ulnar nerves in 12 patients, median nerves in 10 patients, radial nerve in 1 patient, and both the radial and median nerve in 1 patient. The length of nerve grafts ranged from 1-12.5 cm (mean, 4.8 cm). The follow-up period ranged from 18 months to 10 years. Acceptor site-related problems were noted in 51%% (n = 21) of patients. Donor-site morbidity was seen in 4 patients (10%%). The return of function was scored as "good" in 3 (7%%), "fair" in 11 (27%%), and "bad" in 27 (66%%) patients. The outcome of autologous nerve grafts in this small group of patients treated by several surgeons was unfavorable in terms of function. Recent experimental and clinical studies with biodegradable nerve guides for the repair of peripheral nerve gaps showed superior results in comparison to classic nerve grafts.