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Peripheral nerve injuries
 

Peripheral nerve injuries

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    Peripheral nerve injuries Peripheral nerve injuries Presentation Transcript

    • Peripheral Nerve Injuries:Repair and ReconstructionDr hawre
    • • ANATOMY OF THE PERIPHERAEL NRVES• PHYSIOLOGY OF THE PERIPHERAL NERVE
    • ANATOMY OF THE PERIPHERAEL NRVESGross Anatomy Neuronal and Neural Anatomy
    • Gross Anatomy
    • Neuronal and Neural Anatomy
    • Neuronal and Neural Anatomy
    • Topography
    • IntraneuralTopography
    • PHYSIOLOGY O F THEPERIPHERAL NERVEBlood Supply and theBlood-Nerve Barrier
    • Physiology of the peripheral nerve• Excursion
    • Excursion• Mesoneurium• Bands of fontana• Epineurium
    • The cellular response to nerve injury• The injured nerve must survive• The distal end must create an invitingenvironment• The target end organ must be able to receivethe regenerating axon
    • The Neuronal Responseto AxotomyCell support Apoptotic cell death
    • MacrophageGlial cellTarget tissueNeurotrophic factor
    • Apoptotic cell death• Sensory neurons• Developing neurons• More proximal lesions
    • The Neuronal Responseto Axotomy
    • Formation and progression of theregenerating unitProximal unitDistal environment
    • Mechanisms of neuronal regeneration
    • THE CLINICAL EVALUAETION OF NERVEINJURIES: SEDDON AND SUNDERLANCLASSIFICATION AND THEMACKINNON MODIFICATION
    • Six degree injury:neuroma-in-conontinuity
    • Clinical evaluationHistory and examination Electrodiagnostic test
    • Electrodiagnostic test
    • Intraoperative NAP
    • Hour-glass appearance
    • cable nervegrafts.
    • rosebudt"e chniquein,
    • Epineural Versus Fascicular Repair
    • PRINCIPLES OF NERVE REPAIR• l. Quantitative assessment• 2. Microsurgical technique• 3. Tension-free repair• 4. Primary repair is performed when feasible.• 5.nerve graft• 6. Postural maneuvers cannot substitute for a• tension-free repairwith grafting• 8. Repair is delayed for a minimum of 3 week• 9. Postoperative early movement• 10. Preoperativep hysicalt herapy
    • THE CLINICAL CLASSIFICATIONOF NERVE INJURIES: SEDDONAND SUNDERLANDCLASSIFICATIONS AND THEMACKINNON MODIFICATION