Peripheral Nerve Regeneration A Follow-Up Study of 3,656 World War II Injuries (1957) / Chapter Skim
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Autonomic Recovery
Autonomic Recovery
Pages 341-348
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From page 341... ...
The effects of level of injury, associated injuries to major arteries, bones, and joints, time of operation, length of gap, suture material, and other features of the nerve wound and of its operative treatment have been viewed in the light of statistical analysis divorced, insofar as possible, from the preconceptions of the authors. An attempt has been made also to study the relations among the indices which have been used to assess autonomic recovery and to determine the relation of recovery of autonomic functions to those of sensation and motor power.
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From page 342... ...
There is, however, no evidence fur ciisassociatijn between sudomotor and vasomotor recovery, and individuals with clearly elevated skin resistance or absence of sweating in the distribution of an injured nerve may be classified as failures insofar as autonomic recovery is concerned. Certain differences, both anatomical and physiological, will be recalled between sympathetic innervation and that of the somatic motor and sensory systems.
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From page 343... ...
Table 199. -- Percentage of Cases With Evidence for Impaired Autonomic Recovery After Suture of Various Nerves Complaint of "loss of sweating" Increased skin resistance Objective loss of sweating Nerves injured Total area Autonomous area Total area Autonomous area Mecli.m orly 5.4 2.4 1.2 8.5 3.6 9.9 9.1 11.7 9.7 10.3 13.1 1.7 19.0 11.5 24. 1 9.4 23.6 9.1 25.3 31.6 8.6 32.1 21.8 27.7 26.4 31.5 18.2 9.1 11.5 0 16.0 25.0 37.9 47.4 36.0 50.0 22.7 17.3 20.0 24.0 33.3 27.6 15.8 24.0 33.3 Ulnp.r oi^Iy Radial only MicHan plus ulnar*
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From page 344... ...
Associated injury to radial or ulnar nerves does not affect the observed degree of recovery after median nerve injury; autonomic recovery following peroneal suture, similarly, is unaffected by the presence of associated tibial lesions. It would therefore appear, for nerves heavily supplied with autonomic fibers (i.
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From page 345... ...
Surprisingly enough, features as discouraging as a delay for as much as 6 to 12 months between injury and operation, the recognition of excessive tension on the suture line, or the necessity for transposition, extensive mobilization or even a preliminary bulb suture are not correlated with evidence of impaired autonomic recovery. On the other hand, the observation at operation that the condition of the nerve ends was "poor" or "very poor," although it is not associated with an increased incidence of complaints of diminished sweating, is correlated with elevated skin resistance at follow-up study.
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From page 346... ...
Sweating tests, although done on relatively few patients, confirm this observation. The correlation between the British summary of motor recovery and recovery of normal skin resistance is hi^'n for thi median and ulnar nerves, but not for the tibial and sciatic-tibia!
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From page 347... ...
Decreased skin resistance, on the other hand, is not significantly correlated with any of the listed complaints, nor with objective tests of sweating. Objective absence of sweating is, however, significantly correlated, as expected, with increased skin resistance.
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