In our paper (1), we summarized the iatrogenic nerve injuries treated surgically in our department. We saw several patients with recurrent laryngeal nerve palsy after surgery (thyroid or anterior cervical spine surgery) at our outpatient clinic. In some of these patients, the palsies disappeared spontaneously. In cases of complete transection of this thin nerve, it is impossible for us to perform a nerve reconstruction. Since the ends of the severed nerve retract, the chances to discover them are slim. We recommend that in these cases reconstructive procedures should be performed by ETN specialists.
Iatrogenic hypoglossal nerve injuries require treatment by a peripheral nerve surgeon. We have not had this type of lesion in our patient population. If no reinnervation can be demonstrated clinically or by electromyography, surgical exposure and nerve reconstruction is indicated, unless the nerve was clearly severed during the operation. In these cases, primary end-to-end suture or early secondary surgical treatment should then be performed within 3 weeks (2).
We believe that in cases with iatrogenic nerve injury a reconstruction of the nerve should be performed by a surgeon specialized in peripheral nerve surgery. This is the governing principle that peripheral nerve surgeons should always follow. However, if the damage to the nerve is extensive or autologous grafting cannot be performed for various reasons, the option of a nerve transfer should be considered (3). Various nerve transfers can be performed, including
the Oberlin transfer (coaptation of a fascicle of the ulnar nerve to the biceps branch of the musculocutaneous nerve) at the upper arm (4)
a transfer of the triceps branch of the radial nerve to the motor portion of the axillary nerve in the shoulder region (3)
a transfer of motor branches of the median nerve to the radial nerve branches for hand and finger extension at the proximal forearm (5, 6) or
the diversion of the final path of the anterior interosseous nerve to the motor portion of ulnar nerve at the distal lower arm (7).
We believe that tendon transfers are indicated in cases where reinnervation was unsuccessful. The primary aim should always be to restore the continuity of the nerve to maintain the original situation. In our opinion, muscle and tendon transfers are a substitute and should not be regarded as more than this (2).
Ultimately, it would be best to prevent iatrogenic nerve injuries from happening in the first place. However, if they still occur after surgery, they should be detected and addressed. The patient requires treatment in a center specialized in peripheral nerve surgery within the timeframes detailed in our article.
Footnotes
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists.
References
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