In their review, the authors highlight a major and serious complication of surgical procedures. They clearly show that with proper diagnosis and treatment the problems experienced by affected patients can be significantly reduced (1). Regrettably, the article does not mention tendon transfers as an important option for (early) restoration of motor function.
In many cases, satisfactory reinnervation after injury and nerve reconstruction cannot be achieved, especially in older patients, as the ability of peripheral nerves to regenerate significantly declines with advancing age (2, 3). In this situation, functional reconstruction by means of tendon transfer significantly improves the outcome for the affected patients. This surgical technique functionally replace muscles which have lost their motor function with intact muscles or tendons. By transferring these muscles, the lost motor function can often be partially or completely restored.
Good examples are the Bridle procedure to treat foot drop after peroneal injury and tendon transfer surgery to restore finger and wrist extension following radial nerve palsy (4). Here—as the authors point out—an intensive physiotherapy program is essential to prevent contractures which may make it impossible to use tendon transfers. At times, an approach combining nerve reconstruction with tendon transfer may be useful.
These important options for the treatment of traumatic or iatrogenic injury to peripheral nerves of the extremities should always be taken into account when deciding on the further management of these patients.
Dr. med. Tobias Hirsch
Prof. Dr. med. Marcus Lehnhardt
Klinik für Plastische Chirurgie und Schwerbrandverletzte,
Handchirurgiezentrum, Operatives Referenzzentrum für Gliedmaßentumore
BG Universitätskliniken Bergmannsheil, Ruhr Universität Bochum
|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.||Brüser P: Motorische Ersatzoperationen an der oberen Extremität. Dtsch Arztebl 1999; 96: A-1134–9 VOLLTEXT|
|3.||Rosén B, Lundborg G: The long term recovery curve in adults after median or ulnar nerve repair: a reference interval. J Hand Surg Br 2001; 26:196–200 CrossRef MEDLINE|
|4.||Steinau HU, Tofaute A, Huellmann K, et al.: Tendon transfers for drop foot correction: long-term results including quality of life assessment, and dynamometric and peobarographic measurements. Arch Orthop Trauma Surg 2011; 131: 903–10. CrossRef MEDLINE|