Recent conclusions regarding the reconstructive microsurgery of peripheral nerves. 2008

Doina Dumitrescu-Ionescu
Plastic and Reconstructive Microsurgery Clinic, University Hospital, Bucharest. ddumitrescu2004@yahoo.com

The introducing of reconstructive microsurgery has meant not only the addition of microsurgical microscopes and instruments, but a change, a progress towards a new concept, the concept of the microsurgical reconstruction of tissues. The microscope and the instruments themselves are only a means of utilizing this new concept to good effect since the mere use of the microscope and of the instruments according to the old concept of tissue reconstruction cannot be considered to be reconstructive microsurgery. From December 1979 through to December 2005, more than 3000 patients with peripheral nerve lesions were operated on by the same microsurgeon, the author Doina Ionescu-Dumitrescu. The conclusions are based on the following: A huge amount of work involved in carrying out microsurgical reconstructions of over 7500 peripheral nerves in over 3000 patients, 1800 of which were nerve transplants for defects of peripheral nerves of the extremities, for posttraumatic brachial plexus paralyses (91), for replantations and/or revascularizations following partial or complete amputations of the extremities (24 out of which 23 successful) or for free transfers of functional composite tissues (53). For a more accurate picture of such an effort one should consider the operation time that these types of reconstruction involve: between 3 and 12 hours for each patient under general anaesthesia and for both the anaesthetist and the microsurgeon. Experimental microsurgery on rabbit ears The results of the histopathological examination of 500 postoperative neuromas of peripheral nerves repaired traditionally. The Moberg test. Pre, intra and postoperative monthly observations of the patients until their full recovery according to the criteria set by the International Reconstructive Microsurgery Society (postoperative intervals of 6-12-24 months). Taking pictures and recording pre, intra and postoperative stages. The patients' professional, social and familial reintegration. The patients' state of mind; level of cooperation. Comparing results with those of classic and palliative repairs. Comparing the data resulting from this experience with the information provided by the specialist literature of the world. Completing the internationally defined reconstructive procedures with the personal ones, to produce a new concept.

UI MeSH Term Description Entries
D008297 Male Males
D008866 Microsurgery The performance of surgical procedures with the aid of a microscope.
D009416 Nerve Regeneration Renewal or physiological repair of damaged nerve tissue. Nerve Tissue Regeneration,Nervous Tissue Regeneration,Neural Tissue Regeneration,Nerve Tissue Regenerations,Nervous Tissue Regenerations,Neural Tissue Regenerations,Regeneration, Nerve,Regeneration, Nerve Tissue,Regeneration, Nervous Tissue,Regeneration, Neural Tissue,Tissue Regeneration, Nerve,Tissue Regeneration, Nervous,Tissue Regeneration, Neural
D010525 Peripheral Nerves The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. Endoneurium,Epineurium,Perineurium,Endoneuriums,Epineuriums,Nerve, Peripheral,Nerves, Peripheral,Perineuriums,Peripheral Nerve
D011817 Rabbits A burrowing plant-eating mammal with hind limbs that are longer than its fore limbs. It belongs to the family Leporidae of the order Lagomorpha, and in contrast to hares, possesses 22 instead of 24 pairs of chromosomes. Belgian Hare,New Zealand Rabbit,New Zealand Rabbits,New Zealand White Rabbit,Rabbit,Rabbit, Domestic,Chinchilla Rabbits,NZW Rabbits,New Zealand White Rabbits,Oryctolagus cuniculus,Chinchilla Rabbit,Domestic Rabbit,Domestic Rabbits,Hare, Belgian,NZW Rabbit,Rabbit, Chinchilla,Rabbit, NZW,Rabbit, New Zealand,Rabbits, Chinchilla,Rabbits, Domestic,Rabbits, NZW,Rabbits, New Zealand,Zealand Rabbit, New,Zealand Rabbits, New,cuniculus, Oryctolagus
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000673 Amputation, Traumatic Loss of a limb or other bodily appendage by accidental injury. Amputations, Traumatic,Traumatic Amputation,Traumatic Amputations
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia
D017933 Peripheral Nervous System The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. Nervous System, Peripheral,Nervous Systems, Peripheral,Peripheral Nervous Systems,System, Peripheral Nervous,Systems, Peripheral Nervous

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