Oral Presentation New Zealand Association of Plastic Surgeons Annual Scientific Meeting

Radial Nerve Neurolysis, Decompression and Lateral Intermuscular Septum Release - Pathway to Fast Complete Recovery (1688)

Samitha Prasad Iddagoda Hewage Don 1 , Dammika Dissanayake 2
  1. Plastic and Reconstructive Surgery Department, Waikato DHB, Hamilton, Waikato, New Zealand
  2. Plastic and Reconstructive Surgery Department, National Hospital Sri Lanka, Colombo, Sri Lanka

Introduction
Mid humerus shaft fracture itself or subsequent operative procedures can cause damage to radial nerve. But more often nerve injury occurs when it is entrapped in fracture callous healing or cicatrization processes of tissue healing where the nerve is structurally intact but functionally obtunded.
Although a slow natural recovery could be expected, surgical decompression would help fast nerve regeneration, thus faster and complete muscle recovery.

Methodology
This is a prospective cohort study. We selected 15 patients with post humerus fracture radial nerve paralysis with signs of incomplete recovery at the end of 8-12 weeks during last 5 years.
Radial nerve exploration was carried out through the previous incision or through posterior approach. Meticulous dissection was performed from naive tissues proximally. Radial nerve is identified between the heads of Triceps and released from the scar / callous completely working through to the lateral intermuscular septum.
Neurolysis was done across 2/3 of the circumference of the nerve or nerve fascicles if intraneuronal neurolysis had to be performed. We always kept a vascularized tissue bridge over 1/3 circumference. Minimal tissue trauma and absolute hemostasis were practiced.
Lateral intermuscular septum was identified, and nerve was decompressed through to the anterior arm dividing the fascial attachments. Intermuscular repositioning of the nerve was done.

Results
Age ranged from 25-56 years and Female:Male was 1:1. All had intact radial nerve but entrapped in moderate to severe scar tissues.
Immediate post op, all reported feeling improved muscle strength and muscle pain. Two-week follow-up showed evidence of rapid muscle power recovery and all patients recovered completely after 6 weeks post procedure.

Conclusion
We believe neurolysis expedites muscle recovery avoiding the necessity for tendon transfers. It restores individual finger extension much needed to operate a computer key board making it superior to tendon transfers in achieving full bio-mechanical recovery.

  1. 1) Schwaiger K, Abed S, Russe E, Koeninger F, Wimbauer J, Kholosy H, Hitzl W, Wechselberger G. Management of Radial Nerve Lesions after Trauma or Iatrogenic Nerve Injury: Autologous Grafts and Neurolysis. J Clin Med. 2020 Nov 26;9(12):3823. doi: 10.3390/jcm9123823. PMID: 33255889; PMCID: PMC7760920.
  2. 2) Esquenazi Y, Park SH, Kline DG, Kim DH. Surgical management and outcome of iatrogenic radial nerve injection injuries. Clin Neurol Neurosurg. 2016 Mar;142:98-103. doi: 10.1016/j.clineuro.2016.01.014. Epub 2016 Jan 12. PMID: 26827167.
  3. 3) Kim DH, Kam AC, Chandika P, Tiel RL, Kline DG. Surgical management and outcome in patients with radial nerve lesions. J Neurosurg. 2001 Oct;95(4):573-83. doi: 10.3171/jns.2001.95.4.0573. Erratum in: J Neurosurg 2002 Jan;96(1):162. PMID: 11596951.