The Effectiveness of Pure External Neurolysis on the Treatment of Major Motor Nerve Injuries in the Paediatric Population
Rong R Khaw, MBChB (Hons), MRes Med Sci, MRCSEd, Li Y Yong, MBChB, MSc, MRCS and Pundrique Sharma, FRCS(Plast), MRCS, MBBS(MD) PhD, BSc(Hons), Alder Hey Children's Hospital, Liverpool, United Kingdom
Introduction
The clinical and scientific evidence underpinning the efficacy of pure external surgical neurolysis in the treatment of traumatic neuropathies in the paediatric population is still lacking and poorly understood.
Materials & Methods
We conducted a retrospective case series on all paediatric patients treated at a tertiary paediatric plastic surgery centre in the UK with external neurolysis for electromyograph (EMG) proven major motor nerve palsies. All patients who had concurrent neural surgical procedures, i.e. nerve transfers, were excluded. Primary outcomes include pre-and post-operative outcomes (presence or absence) of selective muscle group movements and active range of movement. A literature review on PubMed was conducted with the search terms ((nerve injury) OR (nerve palsy)) AND (neurolysis). We discuss the potential mechanism and efficacy of neurolysis in the paediatric population with reference to the literature and the cases presented.
Results
We identified a total of 5 patients (male=3; female=2) over a period of 3 years, age range 10-15 years. The median time from injury to surgery was 6 months. Nerves involved included the common peroneal nerve (n=3) and brachial plexus upper trunk (C5/C6) (n=2). Immediate improvement in range of movement was observed at day 1 post-operative except for 1 patient, with all showing improvement in the longer term. There were no post-operative complications. Intra-op fresh frozen histology of excised tissue was available for 1 patient showing evidence of scar fibrosis. The literature review suggested clinical benefit from pure external neurolysis in a select group of patients.
Conclusion
The beneficial effects of pure external neurolysis can be immediate and clinically apparent by day 1 post-intervention. We recommend that pure external surgical neurolysis should be considered as a first line treatment in this patient group as it is a relatively low risk surgical intervention with excellent therapeutic value.
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