History and research in Hand Surgery

Hand Surgery has a long history, which can be dated back to as early as 2800 B.C., when the first hand injuries and their treatment were described. Later, both Hippocrates and Homeros in the Iliad described hand and arm injuries and their treatment. The development of hand surgery is shown by the description of a hand transplantation in “The fourth hand” by Irvine.

The successful development of hand surgery is much based on research, where the use of free skin grafts in syndactyly was described already 1890. Among the earliest published articles related to hand surgery it is noteworthy to mention treatment of bacterial infection in the tendon sheaths, polydactyly, surgical technique for use in tenosynovitis and the correlation between ulna minus variance and Kienböck’s disease. Through the years an extensive amount of scientific articles have been authored and published by Swedish hand surgeons. Among the subjects that Swedish hand surgeons have and are presently focused on, the following areas should be mentioned:

Arthroplasties
Bone healing and fractures
Cerebral palsy
Cerebral plasticity
Congenitial malformations
Consequences of hand injuries
Dupuytren’s contracture
Epidemiology
Flexor and tendon healing
Health economy
Nerves and nerve injuries
Paediatric hand injuries
Tetraplegic surgery
The diabetic hand

One should also stress that the research in these areas covers both experimental and clinical studies.

National Centers

Göteborg
Linköping
Malmö-Lund:
– www.med.lu.se/klinvetmalmo/hand_surgery
– www.research.med.lu.se/en_projektdetaljer.php?Proj=563
Stockholm
Umeå
Uppsala
Örebro

Research summary

Peripheral nerve injuries: from signal transduction to socio-economical consequences

Principal investigator; Dahlin, Lars, Professor, MD/PhD

Clinical speciality:

Phone: +040-331724

Co-workers: Clas Backman, MD, PhD; Eleana Bontioti, MD, PhD; Jerker Brandt, MD, PhD;Ingela Carlsson, OTR; Ragnhild Cederlund, PhD, OTR; Elinor Ljungberg, MD; Hans-Eric Rosberg, MD, PhD; Peter Scherman, MD, PhD; Niels Thomsen, MD; Annika Widerberg, MD, PhD

Hand injuries affect patients at all ages, particularly young persons early in their professional life. The most difficult problem to treat is a peripheral nerve lesion which may extend from the common nerve compression lesion, e.g. carpal tunnel syndrome, to severe lacerations in the brachial plexus which are rare. Consequences for patients due to impaired sensory and motor functions can be extensive. The conditions affect both professional and leisure activities. To treat such injuries we have to improve the clinical strategies, directed to various targets for treatment, since an isolated nerve lesion affects not only the distal target but also central brain components. A systemic disease, like diabetes, may also affect hand function and the nervous system, i.e. neuropathy, which is a specific problem.

We focus, in experimental and clinical studies, on signal transduction pathways in neurons and Schwann cells in nerve compression and after nerve transection, on time aspects of regeneration mechanisms after conventional nerve repair and reconstruction and on outcome, including coping mechanisms and health economics, after nerve injuries in children and adults. Furthermore, we address the problem of diabetic neuropathy with focus on improved diagnostic methods, particularly treatment of a nerve compression lesion in diabetes. In experimental studies we utilise immunocytochemistry, in situ hybridisation and electrophoreses together with functional tests. In clinical projects, various outcome instruments are used to study effects of treatment of carpal tunnel syndrome in patients with diabetes with and without neuropathy. Function, health, disability, life quality, coping mechanisms and costs for society are analysed after severe hand injuries including nerve injuries. We collaborate with national and international institutions.

The project approaches the problem of hand injuries, particularly diabetic neuropathy and nerve injuries with different severity, from a holistic point – from molecule to man, thus translational research.

Link to project homepage: http://www.med.lu.se/klinvetmalmo/hand_surgery

5 recent original publications

Nilsson A, Moller K, Dahlin LB, Lundborg G, Kanje M
Early changes in gene expression in the dorsal root ganglia after transection of the sciatic nerve; effects of amphiregulin and PAI-1 on regeneration
Brain Res Mol Brain Res. 2005; 136: 65-74

 

Kataoka K, Kanje M, Dahlin LB
Induction of activating transcription factor 3 after different sciatic nerve injuries in adult rats
Scand J Plast Reconstr Surg Hand Surg. 2007; 41: 158-166

 

Cederlund R, Thomsen N, Thrainsdottir S, Eriksson KF, Sundqvist G, Dahlin LB
Hand disorders, hand functions and activities of daily living in elderly men with type 2 diabetes
Journal of Diabetes and Its Complication. ; : In press

 

Kvist M, Lemplesis V, Kanje M, Ekberg H, Corbascio M, Dahlin LB
Immunomodulation by costimulation blockade inhibits rejection of nerve allografts
J Peripher Nerv Syst. 2007; 12: 83-90

 

Thomsen N, Cederlund R, Rosén I, Björk J, Dahlin LB.
Clinical Outcomes of Surgical Release among Diabetic Patients with Carpal Tunnel Syndrome: A Prospective Follow-up with Matched Controls.
J Hand Surg (Am) . 2009; 34: 1177-87

Further publications here (new window)

Financing/year

Total financing:	4.8 MSEK		Gov grant for clinical research (“ALF”):	1.2 MSEK
Total external financing:	3.6 MSEK		Natl and intl prioritized grants:	1.2 MSEK

Dept of Hand and Plastic Surgery, Umeå University and University Hospital

PERIPHERAL NERVE GAP INJURY
Traumatic peripheral nerve injury represents a major clinical challenge, particularly when accompanied by a loss of tissue leading to long nerve gaps. Even with advanced microsurgical techniques, functional recovery following repair of long nerve gap injury is usually very poor. In addition, the use of autologous nerve grafts to bridge the gap results in morbidity at the donor site. To improve the functional outcome of nerve gap repair, retrograde death of sensory and motor neurons should be prevented by local survival factors. Secondly, axons should be stimulated to regrow and find their way to appropriate targets. Hence, a combination of growth stimuli and guiding structural cues are essential. For this purpose, a bioengineered scaffold incorporating neurotrophic growth factors, or genetically engineered cells producing such factors, would serve both to support neuronal survival and axonal regeneration, and to replace lost nervous tissue.

Research objectives
Following peripheral nerve injury, our research aims at
– studying the responsiveness of different groups of injured neurons to nerve growth factors and guidance molecules.
– investigating the expression in normal and injured nerve tissue of guidance molecules and other signals that influence axonal regeneration.
– studying the synergism of trophic factors and extracellular matrices in promoting and guiding regeneration of injured axons.
– examining the actions of stem cells and Schwann cells in regeneration and remyelination of injured axons.
– developing versatile implantable materials and cell lines facilitating axonal regeneration over and beyond injury gaps.
– validating nerve repair strategies by monitoring of structural repair and functional recovery

Information
Professor Mikael Wiberg
Phone: + 46 90-7852672 (secr)
E-mail: mikael.wiberg@handsurg.umu.se