Peripheral nerve injuries

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Peripheral nerve injuries

  1. 1. Peripheral Nerve Injuries:Repair and ReconstructionDr hawre
  2. 2. • ANATOMY OF THE PERIPHERAEL NRVES• PHYSIOLOGY OF THE PERIPHERAL NERVE
  3. 3. ANATOMY OF THE PERIPHERAEL NRVESGross Anatomy Neuronal and Neural Anatomy
  4. 4. Gross Anatomy
  5. 5. Neuronal and Neural Anatomy
  6. 6. Neuronal and Neural Anatomy
  7. 7. Topography
  8. 8. IntraneuralTopography
  9. 9. PHYSIOLOGY O F THEPERIPHERAL NERVEBlood Supply and theBlood-Nerve Barrier
  10. 10. Physiology of the peripheral nerve• Excursion
  11. 11. Excursion• Mesoneurium• Bands of fontana• Epineurium
  12. 12. 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
  13. 13. The Neuronal Responseto AxotomyCell support Apoptotic cell death
  14. 14. MacrophageGlial cellTarget tissueNeurotrophic factor
  15. 15. Apoptotic cell death• Sensory neurons• Developing neurons• More proximal lesions
  16. 16. The Neuronal Responseto Axotomy
  17. 17. Formation and progression of theregenerating unitProximal unitDistal environment
  18. 18. Mechanisms of neuronal regeneration
  19. 19. THE CLINICAL EVALUAETION OF NERVEINJURIES: SEDDON AND SUNDERLANCLASSIFICATION AND THEMACKINNON MODIFICATION
  20. 20. Six degree injury:neuroma-in-conontinuity
  21. 21. Clinical evaluationHistory and examination Electrodiagnostic test
  22. 22. Electrodiagnostic test
  23. 23. Intraoperative NAP
  24. 24. Hour-glass appearance
  25. 25. cable nervegrafts.
  26. 26. rosebudt"e chniquein,
  27. 27. Epineural Versus Fascicular Repair
  28. 28. 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
  29. 29. THE CLINICAL CLASSIFICATIONOF NERVE INJURIES: SEDDONAND SUNDERLANDCLASSIFICATIONS AND THEMACKINNON MODIFICATION

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