Fig. 51.1
Surgical details of the technique. The free edge of the epineurium at the distal stump is rolled back distally after transection. (a) A 2-mm exposed segment of the distal nerve is resected and the epineural sleeve is anchored to the epineurium of the proximal nerve with two 10-0 sutures placed 180° apart. (b, c) Epineural sleeve is pulled over the proximal nerve and sutures are knotted (d)
Evaluation
Functional recovery was evaluated by walking track analysis, limb circumference ratio, and toe contracture measurements at 1, 2, 4, 8, and 12 weeks. The print length (the distance from the heel to the toe), the toe spread (the distance from the first toe to the fifth toes), and the intermediary toe spread (the distance from the second to the fourth toes) were measured for the walking track analysis and the sciatic function index (SFI) were calculated using these parameters according to the formula described by Bain et al. [8].
The mean limb circumference ratio was determined by the ratio of the operated right site to the unoperated left site.
Toe contracture was measured as a relation of the toes to the foot at the metatarsophalangeal joint at the end of the study, and was graded as normal, mild, moderate, and severe.
Statistical Analysis
Statistical analyses were performed using SPSS 7.0 software for Windows (Chicago, IL). Kruskal-Wallis test and Dunn’s multiple comparison tests were used to evaluate the difference between the groups and to locate the difference. The chi-squared test was used to evaluation of ankle and toe contracture.
Findings
Epineural sleeve group provided faster functional recovery of the sciatic nerves when compared with the conventional repair group. SFIs revealed better results in the epineural sleeve group at 4 weeks and this trend continued up to 12 weeks (Fig. 51.2). Differences between the groups were statistically significant at 4 and 8 weeks (p < 0.05).
Fig. 51.2
Sciatic function index. Statistically significant differences between the groups at 4 and 8 weeks (p < 0.05). Epineural sleeve group reveals better results at 4 weeks and this trend continues up to 12 weeks