End-to-side repair &nerve conduitstechniqueNickolaos A. Darlis, MD, PhDTo access this presentation on the web:
DONORUninjuredRECIPIENTInjuredThe problem:“Missing” proximal stump oftransected nerve
Terminal sproutingCollateral nervesproutingCOLLATERAL NERVE SPROUTING• Following nerve transection(last mm)• Silicon tube ...
• Collateral Sprouting• Chemotactism by distalstump• Axonal progression byContact Guidance
Courtesy, Marios Lykissas, MD
Double end-to-side repair
Double end-to-side repairCourtesy, Marios Lykissas, MD
“Auto” end-to-side repairFor painful neuromas
“Auto” end-to-side repair
“No window” technique
Epineural window technique
Epineural window technique
Clinical applications• Intact nerve tomusculocutaneous• Ulnar to median at thewrist• Digital nerves• Painfull neuromasSens...
Conduits physiologyProximal DistalAxonsSchwann CellsNeurotrophicFactors
Bioabsorbable Conduits• NeurotubeTM (Synovis)– Polyglycolic acid (PGA), externalcorrugation• NeuraGenTM (Integra)– Collage...
Bioabsorbable Conduits• Semipermeable• Prevent collapse• Bioabsorbable– Neurotube hydrolized by 6 mo– Neurolac by 12 mo• C...
Surgical technique• Resection of nerve ends to intact fascicles• Release tourniquet, hemostasis
Surgical technique• Hydrate conduit in saline
Surgical technique• Conduit length 1 cm more than gap (or more than 2X nerve diameter)• Suture placement5mm
Surgical technique5mm• Flush with heparinized saline (10U per cc)
Surgical technique• Healthy soft tissue coverage• Typical immobilization 3 weeks (except for tendonrepairs)• Sensory re-ed...
Conduit sizes• NeuraGen2, 3, 4, 5, 6, 7mm• Neurotube2.3, 4, 8mmMay combine tubes for larger nerves• Neurolac1.5, 2, 2.5, 3...
ConduitsCurrent clinical indicationshort < 3 cm nerve gapsmainly sensory or mixed nervesCourtesy, John Taras, MD
Thank youTo access this presentation on the web:
End to side nerve anastomosis & nerve conduits surgical technique attikon 2013
End to side nerve anastomosis & nerve conduits surgical technique attikon 2013
End to side nerve anastomosis & nerve conduits surgical technique attikon 2013
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End to side nerve anastomosis & nerve conduits surgical technique attikon 2013

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A presentation on the principles, surgical technique and applications of end-to-side nerve anastomosis and the use of artificial nerve conduits

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End to side nerve anastomosis & nerve conduits surgical technique attikon 2013

  1. 1. End-to-side repair &nerve conduitstechniqueNickolaos A. Darlis, MD, PhDTo access this presentation on the web:
  2. 2. DONORUninjuredRECIPIENTInjuredThe problem:“Missing” proximal stump oftransected nerve
  3. 3. Terminal sproutingCollateral nervesproutingCOLLATERAL NERVE SPROUTING• Following nerve transection(last mm)• Silicon tube induced• End to side repair induced
  4. 4. • Collateral Sprouting• Chemotactism by distalstump• Axonal progression byContact Guidance
  5. 5. Courtesy, Marios Lykissas, MD
  6. 6. Double end-to-side repair
  7. 7. Double end-to-side repairCourtesy, Marios Lykissas, MD
  8. 8. “Auto” end-to-side repairFor painful neuromas
  9. 9. “Auto” end-to-side repair
  10. 10. “No window” technique
  11. 11. Epineural window technique
  12. 12. Epineural window technique
  13. 13. Clinical applications• Intact nerve tomusculocutaneous• Ulnar to median at thewrist• Digital nerves• Painfull neuromasSensoryrecovery morepredictablethan motor
  14. 14. Conduits physiologyProximal DistalAxonsSchwann CellsNeurotrophicFactors
  15. 15. Bioabsorbable Conduits• NeurotubeTM (Synovis)– Polyglycolic acid (PGA), externalcorrugation• NeuraGenTM (Integra)– Collagen (bovine deep flexortendon)• NeurolacTM (Polyganics, Micrins)– Polylactide caprolactone(transparent, slowerdegradation)
  16. 16. Bioabsorbable Conduits• Semipermeable• Prevent collapse• Bioabsorbable– Neurotube hydrolized by 6 mo– Neurolac by 12 mo• Claim to have minimalinflammatory responseCourtesy, John Taras, MDCourtesy, Dean Sotereanos, MD
  17. 17. Surgical technique• Resection of nerve ends to intact fascicles• Release tourniquet, hemostasis
  18. 18. Surgical technique• Hydrate conduit in saline
  19. 19. Surgical technique• Conduit length 1 cm more than gap (or more than 2X nerve diameter)• Suture placement5mm
  20. 20. Surgical technique5mm• Flush with heparinized saline (10U per cc)
  21. 21. Surgical technique• Healthy soft tissue coverage• Typical immobilization 3 weeks (except for tendonrepairs)• Sensory re-education
  22. 22. Conduit sizes• NeuraGen2, 3, 4, 5, 6, 7mm• Neurotube2.3, 4, 8mmMay combine tubes for larger nerves• Neurolac1.5, 2, 2.5, 3 mm
  23. 23. ConduitsCurrent clinical indicationshort < 3 cm nerve gapsmainly sensory or mixed nervesCourtesy, John Taras, MD
  24. 24. Thank youTo access this presentation on the web:

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