Repair methods in peripheral nerves after traumatic injuries: a systematic literature review

Costa, Naely Nobre; Santos, Jennifer Ferreira dos; Aranha, Maria Fernanda de Almeida Cavalcante; Coelho, Erik William Farias; Paes, Victor Leno Silva; Oliveira, Rita de Cássia Silva de

doi:10.1590/acb401225

Naely Nobre Costa

Substantial scientific and intellectual contributions to the study

Conception and design

Acquisition of data

Analysis and interpretation of data

Technical procedures

Statistics analysis

Manuscript preparation

Manuscript writing

Universidade do Estado do Pará – Medical School – Belém (PA) – Brazil.

https://orcid.org/0000-0003-2036-6053

Jennifer Ferreira dos Santos

Conception and design

Acquisition of data

Analysis and interpretation of data

Technical procedures

Statistics analysis

Final approval the version to be published

Universidade do Estado do Pará – Medical School – Belém (PA) – Brazil.

https://orcid.org/0009-0002-7151-6963

Maria Fernanda de Almeida Cavalcante Aranha

Conception and design

Acquisition of data

Analysis and interpretation of data

Technical procedures

Statistics analysis

Final approval the version to be published

Universidade do Estado do Pará – Medical School – Belém (PA) – Brazil.

https://orcid.org/0000-0002-5994-7122

Erik William Farias Coelho

Technical procedures

Manuscript preparation

Manuscript writing

Critical revision

Universidade do Estado do Pará – Medical School – Belém (PA) – Brazil.

https://orcid.org/0009-0006-2151-4539

Victor Leno Silva Paes

Technical procedures

Manuscript preparation

Manuscript writing

Critical revision

Final approval the version to be published

Universidade do Estado do Pará – Medical School – Belém (PA) – Brazil.

https://orcid.org/0009-0004-7514-1219

Rita de Cássia Silva de Oliveira ^** Corresponding author: rita.oliveira@uepa.br

Substantial scientific and intellectual contributions to the study

Technical procedures

Critical revision

Final approval the version to be published

Universidade do Estado do Pará – Medical School – Belém (PA) – Brazil.

https://orcid.org/0000-0003-3835-1183

* Corresponding author: rita.oliveira@uepa.br

Section editor:

Norbert Nemeth https://orcid.org/0000-0002-1162-3778

Conflict of interest

Nothing to declare.

Authors	D1	D2	D3	D4	D5	General
Neubrech et al. (2018)⁶	+	+	–	+	+	+
Sallam et al. (2022)⁷	+	+	+	+	+	+
Shahraki et al. (2022)⁸	+	+	+	+	+	+

Authors	D1	D2	D3	D4	D5	D6	D7	General
Bulstra et al. (2018)⁹	+	+	+	+	+	+	+	+
Smith et al. (2018)¹⁰	+	–	–	–	–	+	+	–
Liu et al. (2018)¹¹	+	–	+	+	+	+	+	+
Yang et al. (2018)¹²	+	–	+	+	+	+	+	+
Rasulic et al. (2018)¹³	–	–	–	–	–	–	–	–
Siqueira et al. (2019)¹⁴	+	+	+	+	–	+	–	+
Siqueira et al. (2019)¹⁵	+	–	+	+	–	+	–	+
Xiao et al. (2019)¹⁶	+	–	+	+	+	+	–	+
Shore et al. (2019)¹⁷	+	+	+	+	–	+	–	+
Li et al. (2019)¹⁸	+	–	+	+	+	+	–	+
Degeorge et al. (2019)¹⁹	+	+	+	+	–	+	+	+
Karabeg et al. (2019)²⁰	+	+	+	+	–	+	–	+
Rasulic et al. (2019)²¹	–	–	+	+	+	+	–	+
Monsivais (2020)²²	+	+	+	+	–	+	+	+
Cao et al. (2020)²³	+	+	+	–	+	+	+	+
Emamhadi et al. (2020)²⁴	+	–	+	+	+	+	–	+
Socolovsky et al. (2020)²⁵	+	–	+	+	+	–	–	+
Pages et al. (2020)²⁶	+	+	+	–	–	+	+	+
Solla et al. (2022)²⁷	+	+	–	+	+	–	–	+
Leversedge et al. (2020)²⁸	+	+	–	+	+	+	+	+
Smith et al. (2020)²⁹	+	–	–	+	+	+	–	+
Souza et al. (2020)³⁰	+	+	–	–	–	+	–	–
Emamhadi et al. (2021)³¹	+	+	+	+	+	+	+	+
Wang et al. (2021)³²	+	+	+	+	–	+	–	+
Dunn et al. (2021)³³	–	+	–	–	+	–	+	–
Tsymbaliuk et al. (2021)³⁴	–	–	+	–	+	–	–	–
Lordache et al. (2021)³⁵	–	+	+	–	–	–	–	–
Temiz et al. (2021)³⁶	–	+	+	–	+	–	–	–
Rasulic et al. (2021)³⁷	+	+	+	+	–	–	+	+
Zhan et al. (2022)³⁸	+	+	+	+	+	+	+	+
Garutti et al. (2023)³⁹	–	+	+	–	–	–	–	–

Authors	Sample number	Age	Method	Injured nerve	Nerve used
Neubrech et al. (2018)⁶	74	Average of 43 years old	Placement of a chitosan nerve tube on the injured nerve	Unspecified sensory nerve of the fingers	Does not fit
Sallam et al. (2022)⁷	85	20 to 58 years old	Microsuture with epineural surgical repair and nerve repair with autologous fibrin glue	Ulnar nerve and median nerve	Does not fit
Shahraki et al. (2022)⁸	30	Average of 35 years old	Suture neurorrhaphy, with amniotic membrane coverage around the nerve	Peripheral nerves	Does not fit
Bulstra et al. (2018)⁹	42	Average of 27.7 years old	Transfer of the spinal accessory nerve to the motor branch of the radial nerve	Brachial plexus: motor branch of the radial nerve	Spinal accessory nerve
Smith et al. (2018)¹⁰	13	Average of 7.4 months old	Nerve transfer from the musculocutaneous nerve to the ulnar nerve fascicle	Musculocutaneous nerve	Ulnar fascicle
Liu et al. (2018)¹¹	21	17 to 51 years old	Phrenic nerve or ulnar nerve transfer to the brachial plexus	Brachial plexus	Phrenic nerve or ulnar nerve
Yang et al. (2018)¹²	95	18 to 58 years old	Nerve transfer	Brachial plexus: median nerve	Ulnar nerve
Rasulic et al. (2018)¹³	60	16 to 52 years old	Nerve grafting, split repair, interfascicular neurolysis, external neurolysis and exploration, as well as nerve transfer in the musculocutaneous and axillary nerve	Spinal nerves C5, C6, C7, C8, and T1	Does not fit
Siqueira et al. (2019)¹⁴	104	0 to 2 years old	Nerve transfer, external neurolysis, nerve grafting or combination of techniques	Injury to C5 and C6 (group 1); C5, C6, and C7 (group 2); C5 to T1 (group 3) and C5 to T1 with associated Horner syndrome (group 4)	Does not fit
Siqueira et al. (2019)¹⁵	76	Upper plexus injuries: average of 24.6 years old; complete brachial plexus palsy: 26.2 years old	Suprascapular nerve repair	Suprascapular nerve	Spinal accessory nerve
Xiao et al. (2019)¹⁶	20	Average of 28.9 years old	Transfer of the spinal accessory nerve to the suprascapular nerve; transfer of the nerve branch from the long head of the triceps to the axillary nerve and transfer of two intercostal nerves to the axillary nerve	C5-C6; C5-C7	Spinal accessory nerve-suprascapular nerve and spinal accessory nerve-suprascapular nerve together with intercostal nerve or long branch of triceps nerve-axillary nerve
Shore et al. (2019)¹⁷	243	Average of 6.7 years old	Neurolysis, median nerve decompression, median nerve sural cable graft, radial nerve decompression and tendon transfer	Median, radial, ulnar nerve, or combination of nerve injuries	Does not fit
Li et al. (2019)¹⁸	16	Average of 27.9 years old	Nerve transfer	Brachial plexus	ulnar nerve
Degeorge et al. (2019)¹⁹	58	Average of 24 years old	Suprascapular nerve	Suprascapular nerve	Accessory spinal nerve
Karabeg et al. (2019)²⁰	40	FCR Group: average age of 37.95 years old; FCU group: average age 38.75 years old	Transfer of tendons innervated by the ulnar or median nerve to the tendon paralyzed by the radial nerve injury, using the flexor carpi ulnaris tendon (FCU) or flexor carpi radialis tendon (FCR)	Radial nerve	Ulnar nerve and median nerve
Rasulic et al. (2019)²¹	36	Average of 21 years old	Use of the proximal stump of the C5 spinal nerve for grafting into the musculocutaneous nerve and axillary nerve. In some cases, the proximal stump of the C6 spinal nerve is used to graft the medial radial and pectoral nerve	Brachial plexus	C5 spinal nerve and C6 spinal nerve
Monsivais (2020)²²	11	5 to 47 years old	Contralateral C7 transfer, standard C5 free graft, and spinal attachment transfer	Median nerve, suprascapular, cutaneous muscle, intercostals T4, T5 and T6	C7, C5 and accessory nerve
Cao et al. (2020)²³	9	Not reported	Nerve graft, obturator nerve trunk transfer and transfer of distal mortal branches of the obturator	Femoral nerve	Obturator nerve
Emamhadi et al. (2020)²⁴	7	14 to 56 years old	Transfer of the motor fascicle of the ulnar nerve to the long head of the triceps branch of the radial nerve	Motor fascicle of the ulnar nerve	Radial nerve
Socolovsky et al. (2020)²⁵	131	16 to 35 years old	Phrenic nerve or musculocutaneous nerve	Musculocutaneous nerve	Phrenic nerve and spinal accessory nerve
Pages et al. (2020)²⁶	29	21 to 59 years old	Nerve root grafting, direct transfer, graft transfer	C5/C6	Musculocutaneous, supraspinal and axillary nerve
Solla et al. (2022)²⁷	83	9 to 28years old	Spinal accessory transfer to suprascapular nerve	Suprascapular nerve	Spinal accessory nerve
Leversedge et al. (2020)²⁸	110	16 to 45 years old	Processed nerve allograft and conduits	Sensory digital nerve	Does not fit
Smith et al. (2020)²⁹	45	7 months old in average	Spinal accessory nerve transfer to suprascapularis and graft repair	C5 - T1	C5 or C6 and spinal accessory nerve
Souza et al. (2020)³⁰	11	24 to 59 years old	Transfer of the motor branch of the brachialis to the anterior interosseous nerve and the supinator branch to the posterior interosseous nerve in a first surgical procedure and transfer of the anterior interosseous nerve to the pronator quadratus branch of the ulnar nerve	Anterior and posterior interosseous nerve	Brachial nerve
Emamhadi et al. (2021)³¹	39	Average of 31 years old	Transfer of the motor fascicle from the ulnar carpal branch of the ulnar nerve was used in the mid-superior brachial plexus, as well as transfer of the intercostal nerves to the biceps branch of the musculocutaneous nerve in the total superior brachial plexus	Cutaneous muscle nerve	Intercostal nerves and ulnar nerve
Wang et al. (2021)³²	27	Average of 33 years old	The lower trunk was mobilized by separating it from the posterior division and the medial cutaneous nerve of the forearm distally. The mobilized lower trunk was then directly approached to an ipsilateral root stump	C5, C6, C7, C8, and T1	Does not fit
Dunn et al. (2021)³³	23	21 to 49 years old	Processed nerve allograft (Avance Nerve Graft; AxoGen, Inc., Alachua, FL)	Sciatic, lateral femoral cutaneous nerve	Does not fit
Tsymbaliuk et al. (2021)³⁴	138	18 to 62 years old	Nerve decompression, nerve suture and nerve grafting using sural nerve	Sciatic, ulnar, median, radial, tibial, common peroneal	Sural nerve in graft cases
Lordache et al. (2021)³⁵	44	7 to 52 years old	Nerve transfer and sural nerve graft	Brachial plexus, ulnar nerve, median, radial, sciatic nerve	Sural nerve in graft cases
Temiz et al. (2021)³⁶	182	3 to 67 years old	Neurolysis, epineural anastomosis and sural nerve graft	Sciatic, peroneal nerve	Sural nerve in graft cases
Rasulic et al. (2021)³⁷	77	12 to 75 years old	External neurolysis, longitudinal epineurotomy, epineurotomy circumferential and interfascicular neurolysis, direct nerve suture, graft	Radial nerve	Not reported
Zhan et al. (2022)³⁸	29	18 to 61 years old	Neurolysis	Lumbosacral plexus injury	Does not fit
Garutti et al. (2023)³⁹	36	Average of 47.5 years old	Direct nerve suture, direct nerve suture reinforced with fibrin glue, direct nerve suture with venous involvement	Lateral radial and ulnar digital nerve, common digital nerve	Does not fit

[1] D1: bias arising from the randomization process; D2: bias due to deviations from the intended intervention; D3: bias due to lack of outcome data; D4: bias in outcome measurement; D5: bias in the selection of the reported result; –Moderate; +Low. Source: Elaborated by the authors.

Repair methods in peripheral nerves after traumatic injuries: a systematic literature review

ABSTRACT