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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

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

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