End-to-Side Neurorrhaphy Technique: Exploring Neuronal Regeneration to Restore Nerve Function

Abstract

Aims: To report the case of a pediatric patient with total left brachial plexopathy (TLBP), exhibiting partially restored motor function and impaired sensitivity, who was treated with the End-to-Side neurorrhaphy (ETSN) technique. Presentation of Case: A 13-year-old female was involved in a car accident. After clinical and imaging evaluation, the diagnostic hypothesis was TLBP with partially restored function and loss of protective sensitivity in the pincer region. A surgical intervention was recommended. Due to case characteristics, ETSN appeared to be the most appropriate technique. Discussion: ETSN is a technique utilized for repairing nerve injuries. It involves suturing the distal end of a transected nerve to the lateral side of a healthy donor nerve, aiming to restore neurons through peripheral plasticity. The regeneration mechanism promoted by this technique shares some similarities with that promoted by standard techniques, with important roles being assigned to Schwann cells (SC), for example.  However, this procedure has its own particularities, which still require further investigation. Generally, ETSN cannot replicate the efficacy of model techniques, but remains valid in select cases, such as instances involving nerve injuries exceeding 3-4 cm or in the absence of donor nerves. Therefore, ETSN stands as a choice and deserves consideration. Conclusion: The patient progressed with a good prognosis and recovered protective sensitivity in the pincer region. ETSN is efficient for peripheral nerve injuries with inaccessible proximal trunks or long nerve defects. The discussion surrounding ETSN remains controversial, making this study essential for expanding scientific knowledge.