Rekonstruktion bei Defekten im neuromuskulären Übergang

Zusammenfassung

Wenn in einem Skelettmuskel als Folge eines traumatischen Defektes oder einer Tumoroperation die Region um die Eintrittsstelle des motorischen Nervs verlorengeht, so kann zur funktionellen Rekonstruktion in Ermangelung eines distalen Nervenstumpfes keine konventionelle Nerventransplantation durchgeführt werden. Wir empfehlen für diese Fälle die Rekonstruktion durch direkte Einpflanzung des Spendernervs in den Muskel. Wir beschreiben ein standardisiertes chirurgisches Verfahren, welches bei 19 Patienten zur Anwendung kam und zu einer motorischen Regeneration vom Kraftgrad M4 führte. Das wesentliche Element dieser Technik besteht in der interfaszikulären Dissektion der Nerventransplantate und einer möglichst weiträumigen Verteilung der Nerventransplantate in dem Muskelgewebe.

Abstract

Loss of muscle tissue at the area of the neuromuscular junction after tumor resection or after trauma precludes the reconstruction with conventional nerve grafts, because the distal nerve stump is absent. For these cases, we recommend direct insertion of the nerve grafts into the muscle. We describe a standardized technique, which has been performed in 19 patients and led to a mean motor recovery of grade M4 after Highet. The key procedure of this technique is the interfascicular dissection of the nerve grafts, which allows a wide distribution of the grafts into the muscle tissue.

Schlüsselwörter

Muskuläre Neurotisation - Nervenregeneration - muskuläre Regeneration - motorische Endplatten - neuromuskuläre Verbindung

Key words

Muscular neurotisation - nerve regeneration - muscular regeneration - motor endplates - neuromuscular junction

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