Millesi, J Bone Joint Surg Am 1972 - Interfascicular Nerve-Grafting of the Median and Ulnar Nerves

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Interfascicular Nerve-Grafting of the Median and Ulnar Nerves

Millesi, Berger, et al.·J Bone Joint Surg Am·1972·497 citations·Case series

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Millesi, Meissl and Berger tested whether tension-free interfascicular nerve grafting restores better function than direct end-to-end repair under tension in median and ulnar nerve defects. Clinical series of microsurgical sural nerve interfascicular grafts in 33 median and 32 ulnar nerves (1964 to 1970), assessing motor grade and two-point discrimination after more than 12 months.

Key Findings

Median nerve, complete loss, followed more than 12 months (n = 16): all improved. 11 of 16 reached M4 to M5 and 9 of 16 recovered two-point discrimination.
Ulnar nerve followed more than 12 months (n = 18): all showed functional return. 8 of 18 reached M4 to M5 and 7 of 18 recovered two-point discrimination.
In 8 of 10 failed primary repairs re-explored at 6 to 12 months, regenerated axons had degenerated in the distal stump, which the authors attributed to tension and scarring at the suture line.
Technique: sural nerve graft (about 35 cm available), 5 to 6 strands for the median nerve and 4 for the ulnar, one 10-0 nylon suture per graft end. The authors grafted gaps over 2 cm with joints extended.
Significance: The paper established microsurgical interfascicular nerve grafting and the principle of tension-free coaptation, showing that axons crossing two tension-free suture lines regenerate better than across one repair under tension.

Board PearlMillesi showed that tension at a direct nerve repair causes scarring and degeneration of regenerated axons distally, so a tension-free sural interfascicular graft outperforms end-to-end repair under tension despite two suture lines.

Interfascicular Nerve-Grafting of the Median and Ulnar Nerves

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Interfascicular Nerve-Grafting of the Median and Ulnar Nerves

Millesi, Berger, et al.·J Bone Joint Surg Am·1972·497 citations·Case series

|

Millesi, Meissl and Berger tested whether tension-free interfascicular nerve grafting restores better function than direct end-to-end repair under tension in median and ulnar nerve defects. Clinical series of microsurgical sural nerve interfascicular grafts in 33 median and 32 ulnar nerves (1964 to 1970), assessing motor grade and two-point discrimination after more than 12 months.

Key Findings

Median nerve, complete loss, followed more than 12 months (n = 16): all improved. 11 of 16 reached M4 to M5 and 9 of 16 recovered two-point discrimination.
Ulnar nerve followed more than 12 months (n = 18): all showed functional return. 8 of 18 reached M4 to M5 and 7 of 18 recovered two-point discrimination.
In 8 of 10 failed primary repairs re-explored at 6 to 12 months, regenerated axons had degenerated in the distal stump, which the authors attributed to tension and scarring at the suture line.
Technique: sural nerve graft (about 35 cm available), 5 to 6 strands for the median nerve and 4 for the ulnar, one 10-0 nylon suture per graft end. The authors grafted gaps over 2 cm with joints extended.
Significance: The paper established microsurgical interfascicular nerve grafting and the principle of tension-free coaptation, showing that axons crossing two tension-free suture lines regenerate better than across one repair under tension.

Board PearlMillesi showed that tension at a direct nerve repair causes scarring and degeneration of regenerated axons distally, so a tension-free sural interfascicular graft outperforms end-to-end repair under tension despite two suture lines.

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