DÄ internationalArchive35-36/2014Early Diagnosis and Treatment
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Congratulations to the authors for choosing this important topic (1). As shown in their review, regeneration after nerve reconstruction is by no means guaranteed (1), in particular not in older patients (2). The most common nerve injury – damage to the median nerve during carpal tunnel surgery (1) – often occurs in middle-aged/ older patients where the prognosis for regeneration is not always favorable. Full recovery of motor function is the exception rather than the rule. Therefore, tendon transfers should already be considered at the time of nerve reconstruction (3). Especially proximal nerve damages with long regeneration distances have a poor prognosis, e.g. injury to the radial nerve associated with osteosynthesis of fractures of the humerus. The various tendon transfers to restore motor function are detailed in the AWMF guidelines for the treatment of peripheral nerve injuries, a publication rightfully cited by the authors of the review.

Although ideally a microsurgeon should be called in cases of intraoperative nerve transection, this is often not practical. We believe that most iatrogenic nerve injuries go unnoticed by the surgeon. On the other hand, it is not uncommon that patients present with unsatisfactory nerve repair where a suture was created with unsuitable suture material under inadequate magnification (microscope/ loupes) without microsurgical technique. As the authors point out in their review, secondary reconstruction by a microsurgeon is certainly more advisable than attempting to perform a nerve suture without the necessary infrastructure and/or adequate microsurgical training.

We agree with the authors’ conclusion that iatrogenic nerve injuries should be diagnosed early and adequately treated by experienced microsurgeons. In addition, these surgeons should also be capable of performing tendon transfers to spare these patients from having to undergo multiple surgical procedures.

DOI: 10.3238/arztebl.2014.0602a

Prof. Dr. med. Frank Unglaub

Medizinische Fakultät Mannheim der Universität Heidelberg,
Mannheim

Abteilung Handchirurgie, Vulpius Klinik,
Bad Rappenau

Prof. Dr. med. Peter Hahn

Abteilung Handchirurgie, Vulpius Klinik,
Bad Rappenau

Dr. med. Christian K. Spies
Abteilung Handchirurgie, Vulpius Klinik,
Bad Rappenau
christian.spies@vulpiusklinik.de

1.
Antoniadis G, Kretschmer T, Pedro MT, König RW, Heinen CPG, Richter HP: Iatrogenic neurological damage—prevalence, diagnosis and treatment. Dtsch Arztebl Int 2014; 111: 273–9. VOLLTEXT
2.
Stang F, Stollwerck P, Prommersberger KJ, van Schoonhoven J: Posterior interosseus nerve vs. medial cutaneous nerve of the forearm: differences in digital nerve reconstruction. Arch Orthop Trauma Surg 2013; 133: 875–80. CrossRef MEDLINE
3.
Prommersberger KJ, van Schoonhoven J: Motorische Ersatzoperationen an der oberen Extremität. Oper Orthop Traumatol 2013; 25: 320. CrossRef MEDLINE
1.Antoniadis G, Kretschmer T, Pedro MT, König RW, Heinen CPG, Richter HP: Iatrogenic neurological damage—prevalence, diagnosis and treatment. Dtsch Arztebl Int 2014; 111: 273–9. VOLLTEXT
2. Stang F, Stollwerck P, Prommersberger KJ, van Schoonhoven J: Posterior interosseus nerve vs. medial cutaneous nerve of the forearm: differences in digital nerve reconstruction. Arch Orthop Trauma Surg 2013; 133: 875–80. CrossRef MEDLINE
3. Prommersberger KJ, van Schoonhoven J: Motorische Ersatzoperationen an der oberen Extremität. Oper Orthop Traumatol 2013; 25: 320. CrossRef MEDLINE

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