• Save
End to side nerve anastomosis & nerve conduits surgical technique attikon 2013
Upcoming SlideShare
Loading in...5
×
 

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

on

  • 873 views

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

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

Statistics

Views

Total Views
873
Views on SlideShare
868
Embed Views
5

Actions

Likes
1
Downloads
0
Comments
0

2 Embeds 5

http://www.orthoinfo.gr 4
https://twitter.com 1

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

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

  • 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 induced• End to side repair induced
  • • 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 neuromasSensoryrecovery morepredictablethan motor
  • Conduits physiologyProximal DistalAxonsSchwann CellsNeurotrophicFactors
  • Bioabsorbable Conduits• NeurotubeTM (Synovis)– Polyglycolic acid (PGA), externalcorrugation• NeuraGenTM (Integra)– Collagen (bovine deep flexortendon)• NeurolacTM (Polyganics, Micrins)– Polylactide caprolactone(transparent, slowerdegradation)
  • 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
  • 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-education
  • Conduit sizes• NeuraGen2, 3, 4, 5, 6, 7mm• Neurotube2.3, 4, 8mmMay combine tubes for larger nerves• Neurolac1.5, 2, 2.5, 3 mm
  • ConduitsCurrent clinical indicationshort < 3 cm nerve gapsmainly sensory or mixed nervesCourtesy, John Taras, MD
  • Thank youTo access this presentation on the web: