Innovative Application of the Ilizarov Technique for Long Nerve Defect Reconstruction: A Detailed Case Report

Abstract

Background: Traditionally known for bone regeneration, the Ilizarov technique’s effectiveness in nerve reconstruction, particularly for extensive nerve damage, has yet to be widely recognized.

Case presentation: This report presents a case study and proposes the innovative use of the Ilizarov technique for reconstructing extended nerve defects. In this study, we reviewed a 43-year-old male diagnosed with an open fracture of the right tibia combined with soft tissue injury resulting in a mangled injury in which a large part of his right tibial bone and nerve were lost. The patient was cured and the sensorimotor function was recovered after distraction osteogenesis by the Ilizarov technique, which is a unique application of this technique to repair a substantial long nerve defect, a rare occurrence in medical literature. It highlights the method of nerve lengthening, which is achieved by attaching the nerve stump to the bone stump. This approach allows for significant nerve regeneration and ensures a stable progression of the nerve, as the bone stump acts as a carrier, overcoming the challenges of direct nerve lengthening.

Conclusions: The adaptability and effectiveness of the Ilizarov technique in a new area suggests the need to reconsider traditional approaches to complex nerve reconstruction. Placing this case within the context of current medical knowledge underscores the potential of this technique to revolutionize the treatment of extended nerve defects, offering hope for improved outcomes in challenging scenarios.

Keywords

Ilizarov technique / nerve lengthening / nerve repair / peripheral nerve defect

References

[1] Howarth HM, Orozco E, Lovering RM, Shah SB. A comparative assessment of lengthening followed by end-to-end repair and isograft repair of chronically injured peripheral nerves. Exp Neurol. 2020; 331: 113328.

[2] Griffin JW, Hogan MV, Chhabra AB, Deal DN. Peripheral nerve repair and reconstruction. J Bone Joint Surg Am. 2013; 95(23): 2144–2151.

[3] Bazarek S, Brown JM, Shah SB. Clinical potential of tension-lengthening strategies during nerve repair. Neural Regen Res. 2022; 17(4): 779–780.

[4] Deal DN, Griffin JW, Hogan MV. Nerve conduits for nerve repair or reconstruction. J Am Acad Orthop Surg. 2012; 20(2): 63–68.

[5] Fink B. Behavior of soft tissue structures in surgical leg lengthening. Orthopade. 1999; 28(12): 1007–1014.

[6] Vaz KM, Brown JM, Shah SB. Peripheral nerve lengthening as a regenerative strategy. Neural Regen Res. 2014; 9(16): 1498–1501.

[7] Howarth HM, Alaziz T, Nicolds B, O’Connor S, Shah SB. Redistribution of nerve strain enables end-to-end repair under tension without inhibiting nerve regeneration. Neural Regen Res. 2019; 14(7): 1280–1288.

[8] Mathieu L, Cloquell Y, Murison JC, Pfister G, Gaillard C, Oberlin C, et al. Defects of the sciatic nerve and its divisions treated by direct suturing in 90 degrees knee flexion: report on the first clinical series. Eur J Trauma Emerg Surg. 2022; 48(6): 4955–4962.

[9] Lubelski D, Halsey J, Suk I, Tuffaha S, Osgood G, Belzberg AJ. Novel approach of femur shortening with insertion of expandable rod to achieve end-to-end repair of sciatic nerve laceration. Oper Neurosurg (Hagerstown). 2023; 24(4): 455–459.

[10] Mathieu L, Pfister G, Murison JC, Oberlin C, Belkheyar Z. Missile injury of the sciatic nerve: observational study supporting early exploration and direct suture with flexed knee. Mil Med. 2019; 184(11–12): e937–e944.

[11] Pfister G, Ghabi A, de Carbonnières A, Oberlin C, Belkheyar Z, Mathieu L. Direct suturing of sciatic nerve defects in high-degree knee flexion: an experimental study. World Neurosurg. 2020; 133: e288–e292.

[12] Wang E, Inaba K, Byerly S, Escamilla D, Cho J, Carey J, et al. Optimal timing for repair of peripheral nerve injuries. J Trauma Acute Care Surg. 2017; 83(5): 875–881.

[13] Rauf R, Pesch S, Huber-Wagner S. Prinzipien der operativen Behandlung bei schwerer Extremitätenverletzung. Notfall + Rettungsmedizin. 2019; 23(6): 429–434.

[14] Xu L, Song H, Ren Y, Fang J, Zhou C, Zhang H, et al. Antibiotic-impregnated calcium sulfate vs. wound irrigation-suction to treat chronic calcaneal osteomyelitis. Foot Ankle Int. 2022; 43(3): 331–342.

[15] Thomas MV, Puleo DA. Calcium sulfate: properties and clinical applications. J Biomed Mater Res B Appl Biomater. 2009; 88(2): 597–610.

[16] Nishiura Y, Yamada Y, Hara Y, Ichimura H, Yoshii Y, Ochiai N. Repair of peripheral nerve defect with direct gradual lengthening of the proximal nerve stump in rats. J Orthop Res. 2006; 24(12): 2246–2253.

RIGHTS & PERMISSIONS

2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.