Documented experience of treatment of digital nerve lesions with the termino-lateral (end-to-side) nerve suture is limited. Our clinical experience of this technique is detailed here alongside a systematic review of the previous literature. We performed, from 2002 to 2008, seven termino-lateral sutures with epineural window opening for digital nerve lesions. Functional outcome was analysed using the two-point discrimination test and the Semmes–Weinstein monofilament test. The results showed a sensory recovery of S3+ in six cases and S3 in one case. The mean distance found in the two-point discrimination test was 12.7 mm (range 8–18 mm). After a review of the literature, we were able to obtain homogeneous data from 17 additional patients operated by termino-lateral coaptation. The overall number of cases included in our review was 24. A sensory recovery was observed in 23 out of 24 patients. The functional results were S0 in one case, S3 in one case, S3+ in twenty cases and S4 in two cases. Excluding the one unfavourable case, the mean distance in the two-point discrimination test was 9.7 mm (range 3–18 mm). It can thus be concluded that the treatment of digital nerve lesions with termino-lateral suture showed encouraging results. Based on the results obtained in this current study we believe that in case of loss of substance, end-to-side nerve coaptation may be an alternative to biological and synthetic tubulisation when a digital nerve reconstruction by means of nerve autograft is declined by the patient.
Al-QattanMM. Terminolateral neurorrhaphy: review of experimental and clinical studies. J Reconstr Microsurg. 2001, 17: 99–108.
2.
AmrSMMoharramAN. Repair of brachial plexus lesions by end-to-side side-to-side grafting neurorrhaphy: experience based on 11 cases. Microsurgery. 2005, 25: 126–46.
3.
BallanceCABalanceHAStewartP. Operative treatment of chronic facial palsy of peripheral origin. Brit Med J. 1903, May 2nd: 1009–13.
4.
BattistonBTosPCushwayTGeunaS. Nerve repair by means of vein filled with muscle grafts. I. Clinical results. Microsurgery. 2000, 20: 32–6.
5.
CalderJSMcAllisterRM. Interpreting the results of digital nerve repair. J Hand Surg Br. 1993, 18: 797–9.
6.
CedernaPSKalliainenLKUrbancheckMGRovakJMKuzonWMJr. Donor muscle structure and function after end-to-side neurorrhaphy. Plast Reconstr Surg. 2001, 107: 789–96.
7.
DumontierCKloosMDapFMerleM. Nerve graft of collateral branches of fingers. Report of a series of 16 reviewed cases. Rev Chir Orthop Reparatrice Appar Mot. 1990, 76: 311–16.
8.
DuplaySReclusP. Trattato di Chirurgia. Torino, Unione Tipografica Editrice Torinese, 1893.
GeunaSPapaliaITosP. End-to-side (terminolateral) nerve regeneration: A challenge for neuroscientists coming from an intriguing nerve repair concept. Brain Res Rev. 2006, 52: 381–8.
12.
GossetJAndrePLevameM. The prevention of amputation neuromas of the fingers and of amputation neuromas in general. Mem Acad Chir (Paris). 1962, 88: 548–50.
13.
GreeneTLSteichenJB. Digital nerve grafting using the dorsal branch of the ulnar nerve. J Hand Surg Br. 1985, 10: 37–40.
14.
HarrisWLawVW. On the importance of accurate muscular analysis in lesions of brachial plexus; and the treatment of Erb’s palsy and infantile paralysis of the upper extremity by cross-union of nerve roots. Br Med J. 1903, 2: 1035–7.
15.
JohnsonEOSoucacosPN. Nerve repair: experimental and clinical evaluation of biodegradable artificial nerve guides. Injury. 2008, 39Suppl. 3S30–6.
16.
KallioPK. The results of secondary repair of 254 digital nerves. J Hand Surg Br. 1993, 18: 327–30.
17.
KennedyR. Suture of brachial plexus in birth paralysis of the upper extremity. Br Med J. 1903, 1: 298–301.
18.
KostakogluN. Motor and sensory reinnervation after end-to-side median to ulnar nerve coaptation in the forearm. Br J Plast Surg. 1999, 52: 402–7.
19.
LandwehrsGMBruserP. Clinical results of terminolateral neurorraphy in digital nerves. Handchir Mikrochir Plast Chir. 2008, 40: 318–21.
20.
LetiévantE. Traité des Sections Nerveuses. Paris, Bailliere Ed., 1873.
21.
LundborgGZhaoQKanjeMDanielsenNKernsJM. Can sensory and motor collateral sprouting be induced by intact peripheral nerve by end-to-side anastomosis?. J Hand Surg Br. 1994, 19: 277–82.
22.
LuoYX. Preliminary investigation of treatment of ulnar nerve defect by end-to-side neurorrhaphy. Plast Reconstr Surg. 1998, 102: 25–8.
23.
LutzBSChuangDCHsuJCMaSFWeiFC. Selection of donor nerves: an important factor in end-to-side neurorrhaphy. Br J Plast Surg. 2000, 53: 149–54.
24.
MackinnonSEDellonAL. Surgery of the peripheral nerve. Thieme Publishing Group. 1988
25.
MennenU. End-to-side nerve suture in clinical practice. Hand Surg. 2003, 8: 33–42.
26.
NoahEMWilliamsAJorgensonC. End-to-side neurorrhaphy: A histologic and morphometric study of axonal sprouting into a end-to-side nerve graft. J Reconstr Microsurg. 1997, 13: 99–106.
27.
OgunTCOzdemirMSenaranHUstunME. End-to-side neurorrhaphy as a salvage procedure for irreparable nerve injuries. J Neurosurg. 2003, 99: 180–5.
28.
PapaliaICardaciAd'AlcontresFSLeeJMTosPGeunaS. Selection of the donor nerve for end-to-side neurorrhaphy. J Neurosurg. 2007a, 107: 378–82.
29.
PapaliaIGeunaSStagno D’AlcontresFTosP. Origin and history of end-to-side neurorrhaphy. Microsurgery. 2007b, 27: 56–61.
30.
PapaliaIGeunaSTosPBouxEBattistonBStagno D'AlcontresF. Morphologic and functional study of rat median nerve repair by terminolateral neurorrhaphy of the ulnar nerve. J Reconstr Microsurg. 2003, 19: 257–63.
31.
PelissierPRihaiRCasoliVMartinDBraudetJ. Les anastomoses nerveuses terminolaterales. Rapport clinique à propos de dix cases. Ann Chir Plast Esthet. 2001, 46: 129–33.
32.
PienaarCSwanMCDe JagerWSolomonsM. Clinical experience with end-to-side nerve transfer. J Hand Surg Br. 2004, 29: 438–43.
33.
PlattHBristowWR. The remote results of operation for injuries of pheriphereal nerves. Br J Surg. 1924, 11: 535–67.
34.
RisitanoGCavallaroGMerrinoTCoppolinoSRuggeriF. Clinical results on utilization of biologic and synthetic tubulisation in the reconstruction of digital nerves. Chir Main. 2002, 21: 194–7.
35.
RowanPRChenLEUrbaniakJR. End-to-side nerve repair: a review. Hand Clin. 2000, 16: 151–9.
36.
SachsEMaloneJY. An experimental study on the methods for bridging nerve defects. Arch Surg (Chicago). 1922, 5: 314–33.
37.
SananpanichKGaleaMPMorrisonWAMessinaA. Quantitative characterization of regenerating axons after end-to-side and end-to-end coaptation in a rat brachial plexus model: a retrograde tracer study. J Neurotrauma. 2007, 24: 864–75.
38.
ViterboFTrinidadeJCHoshinoKMazzoni NetoA. Latero-terminal neurorrhaphy without removal of epineural sheath. Experimental study in rats. Sao Paulo Med J. 1992, 110: 267–75.
39.
ViterboFTrinidadeJCHoshinoKMazzoniA. Two end-to-side neurorrhaphies and nerve graft with removal of the epineural sheath: experimental study in rats. Br J Plast Surg. 1994, 47: 75–80.
40.
VochePQuattaraD. End-to-side neurorrhaphy for defects of palmar sensory digital nerves. Br J Plast Surg. 2005, 58: 239–44.
41.
WalkerJCBrennerMJMackinnonSEWinogradJMHunterDA. Effect of perineurial window size on nerve regeneration, blood–nerve barrier integrity, and functional recovery. J Neurotrauma. 2004, 21: 217–27.
42.
WeberRABreidenbachWCBrownRE. A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans. Plast Reconstr Surg. 2000, 106: 1036–45.
