Lesões traumáticas de nervos periféricos: uma revisão com ênfase na indicação
            cirúrgica

Traumatismos dos nervos periféricos resultam em lesões incapacitantes e estão presentes em muitas das lesões dos membros. A compreensão da fisiopatologia dessas lesões e a seleção do momento operatório mais adequado são imprescindíveis para que o tratamento seja adequado. Neste artigo revisamos a fisiopatologia das lesões traumáticas dos nervos periféricos, apresentamos a classificação mais utilizada dessas lesões e discutimos os principais aspectos relacionados ao momento da cirurgia e às formas de reparo cirúrgico.

nervo periférico; cirurgia de nervo periférico; traumatismo de nervo periférico; enxerto de nervo; reparo do nervo

Autoria

Roberto Sergio Martins

Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo School of Medicine, São Paulo, SP, BrazilUniversity of São Paulo School of MedicineBrazilSão Paulo, SP, BrazilPeripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo School of Medicine, São Paulo, SP, Brazil

Hospital do Servidor Público do Estado de São Paulo, São Paulo, SP, BrazilHospital do Servidor Público do Estado de São PauloBrazilSão Paulo, SP, BrazilHospital do Servidor Público do Estado de São Paulo, São Paulo, SP, Brazil

Dhiego Bastos

Universidade Estadual de Campinas, Campinas, SP, BrazilUniversidade Estadual de CampinasBrazilCampinas, SP, BrazilUniversidade Estadual de Campinas, Campinas, SP, Brazil

Mario Gilberto Siqueira

Carlos Otto Heise

Manoel Jacobsen Teixeira

Correspondence: Roberto S. Martins; Rua Oscar Freire 2250 / cj. 18 térreo; 05409011 São Paulo SP - Brasil; E-mail: robar@ig.com.br

Conflict of interest: There is no conflict of interest to declare.

SCIMAGO INSTITUTIONS RANKINGS

Universidade Estadual de Campinas, Campinas, SP, BrazilUniversidade Estadual de CampinasBrazilCampinas, SP, BrazilUniversidade Estadual de Campinas, Campinas, SP, Brazil

Figuras

Figuras (3)

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Figure 1
. Schematic drawing of a normal nerve fiber and the three grades of nerve injury according to Seddon’s classification.

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Figure 2
. Intraoperative view of ulnar nerve approach in the right forearm. This 22-year-old patient suffered a stab wound 4 months before his presentation at our center. A complete palsy of the ulnar nerve was identified at physical examination and a neurotmesis was demonstrated during surgical procedure. Note the large neuroma of the proximal stump. L: lateral side; P: proximal.

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Figure 3
. Intraoperative photograph showing a sciatic nerve injury at the middle third of the thigh due to a gunshot wound. Since there was no recovery of a complete sciatic nerve palsy the patient was operated 3 months after injury. (A) Initial exposure showing a neuroma (N) in continuity of the sciatic nerve (SN) just before its division. (B) An intraoperative nerve action potential evaluation was performed in order to define if the lesion should be resected. No recordable response was obtained so the neuroma was resected. (C) Surgical view after neuroma resection. (D) Both sural nerves were used to re-establish nerve continuity with nine nerve grafts interposed between proximal and distal stumps. P: proximal; PN: peroneal nerve; R: recording electrode; S: stimulation electrode; TN: tibial nerve.

Figure 1 . Schematic drawing of a normal nerve fiber and the three grades of nerve injury according to Seddon’s classification.

Figure 2 . Intraoperative view of ulnar nerve approach in the right forearm. This 22-year-old patient suffered a stab wound 4 months before his presentation at our center. A complete palsy of the ulnar nerve was identified at physical examination and a neurotmesis was demonstrated during surgical procedure. Note the large neuroma of the proximal stump. L: lateral side; P: proximal.

Figure 3 . Intraoperative photograph showing a sciatic nerve injury at the middle third of the thigh due to a gunshot wound. Since there was no recovery of a complete sciatic nerve palsy the patient was operated 3 months after injury. (A) Initial exposure showing a neuroma (N) in continuity of the sciatic nerve (SN) just before its division. (B) An intraoperative nerve action potential evaluation was performed in order to define if the lesion should be resected. No recordable response was obtained so the neuroma was resected. (C) Surgical view after neuroma resection. (D) Both sural nerves were used to re-establish nerve continuity with nine nerve grafts interposed between proximal and distal stumps. P: proximal; PN: peroneal nerve; R: recording electrode; S: stimulation electrode; TN: tibial nerve.

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Lesões traumáticas de nervos periféricos: uma revisão com ênfase na indicação cirúrgica

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[1] Correspondence: Roberto S. Martins; Rua Oscar Freire 2250 / cj. 18 térreo; 05409011 São Paulo SP - Brasil; E-mail: robar@ig.com.br