Contralateral c7 CC7 transfer
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This document discusses contralateral C7 transfer, a surgical procedure where the unaffected C7 nerve root is used to reinnervate nerves on the affected side for patients with brachial plexus injuries and total root avulsions. It can be done in a single stage by directly coapting the C7 to the recipient nerve, or in a staged procedure using a vascularised ulnar nerve graft to allow for nerve growth. The C7 is used because its muscles are cross-innervated, minimizing function loss on the normal side. Careful patient selection and post-operative physical therapy are important for achieving reinnervation and return of motor function on the affected side.
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- Repair of tendons involves meticulous surgery under magnification to accurately reattach the tendon ends, followed by immobilization or early mobilization
Ulnar nerve laceration
This document discusses ulnar nerve laceration and repair. It begins with the surgical anatomy of the ulnar nerve, then covers classification of nerve injuries. It describes high-level and low-level ulnar nerve injuries, noting differences in presentation. Factors influencing ulnar nerve repair include patient age, injury level and timing of treatment. Surgical approaches depend on injury level, with high lesions repaired and potentially transposed and low lesions addressed through wrist or carpal tunnel releases. Proper patient positioning and splinting aid recovery.
Neuro-Surgical Microscope
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Arthroscopy assisted mpfl reconstruction
This document describes the surgical procedure of arthroscopy assisted MPFL reconstruction. It begins with an overview of the MPFL ligament and indications for reconstruction. The summary is as follows:
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2. The procedure involves graft harvesting, preparation of the patella and femur tunnels, passing the graft and securing it under arthroscopic visualization.
3. Post-operatively, patients follow a protocol of restricted motion and weight bearing to allow healing, with results showing full recovery of function and no further dislocations.
Endovascular Introduction
Endovascular therapy has evolved significantly since its origins in the 1920s. Modern endovascular techniques can now treat nearly all cerebrovascular diseases from within the vessels using catheters, coils, stents, and other devices to occlude or open vessels. The Penumbra system specifically uses a reperfusion catheter and separator to continuously aspirate thrombus in acute ischemic stroke. Case studies demonstrate its effectiveness in restoring blood flow in the MCA, ACA, and other vessels to achieve good patient outcomes.
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Pre-operative evaluation
Bone marrow and cerebrospinal fluid analysis
Orbital imaging – MRI (magnetic resonance imaging ) -to rule out extrascleral tumour extension or gross optic nerve involvement
Gross optic nerve thickening or extrascleral extension- chemoreduction –enucleation is performed as a secondary treatment
GA fitness and relevant Labs
Blood Hb levels of a minimum of 10-12 grams per decilitre
White blood cell count of <15,000 per cubic millimetre
A platelet count of >100,000 per cubic millimetre of blood
Consent with all possible complications and risks
Must note who is signing and accompanying the child
Re-Counselling
Confirm whether parents/caretakers understand what we are going to do
Eye removal
Stoned eye(Prosthesis) will not see
The extent of the disease will be demonstrated by the histopathology
Post Sx - systemic chemotherapy & regular follow-ups
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What is Craniotomy?
What are the Indications for Craniotomy?
What are the Types of Craniotomy?
Equipment used in craniotomy?
What happen to the Bone flap?
What are the Tests Done Prior to Craniotomy?
What happens during surgery?
What are the risks?
References
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This document summarizes a journal club discussion on outcomes of using anterior interosseous nerve transfers to restore intrinsic hand function after high ulnar nerve injuries. The summary includes:
- A study of 17 patients who underwent AIN to MUN nerve transfers for high ulnar nerve injuries found 81% achieved MRC grade 3 or higher recovery of intrinsic function. Three techniques were used for the nerve coaptation.
- A literature review identified 12 similar studies with 102 total patients, finding 86% had good outcomes (MRC grade 3 or higher) and 64% had good sensory outcomes.
- Distal nerve transfers provide a more functional reconstruction than tendon transfers for restoring intrinsic hand function after high ulnar
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Brachial plexus surgery basic concepts
Nerve injuries can occur through various mechanisms and be classified based on severity. Electrodiagnostic studies and imaging help evaluate the degree of injury. For severe injuries, exploration may be needed for neurolysis, neurorrhaphy, grafting, or nerve transfers to restore function. The timing and type of surgical intervention depends on the severity, location, and symptoms in each individual case.
endospine easygo system.pptx
The document describes a new endoscopic spine surgery system called "Easy GO" for performing lumbar discectomies. Some key points:
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- A study of the first patients treated with Easy GO found no complications and postoperative pain relief in 89% of patients at 10 months follow up on average, comparable to results from other techniques.
- While the skin incision size is smaller than open surgery, the extent of decompression and neural tissue trauma is similar to standard microdiscectomy. The
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Acute Tendon injury of the Hand and its Repair.pptx
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Craniofacial Microsomia and Hemifacial Atrophy
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Cephalometry and occlusion of teeth
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BOTOX - Botulinum toxin in aesthesis
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Face lift - Rhytidectomy
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Dupuytren's contracture
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Antero Lateral thigh flap
This document summarizes the anterolateral thigh (ALT) flap, including:
1) The ALT flap has reliable blood supply from branches of the lateral circumflex femoral artery and can provide skin, muscle, fascia and a long pedicle.
2) The anatomy is variable but the flap is typically based on musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery.
3) The ALT flap has been used successfully for reconstruction of the head and neck, esophagus, abdomen, breast, extremities and perineum, with success rates over 95% and versatility in design.
4) Advantages include reliable anatomy, long pedicle, versatility
Anatomy of eyelid and eyelid reconstruction
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Gastrocnemius flap
1. The gastrocnemius muscle consists of medial and lateral heads that are supplied by the medial and lateral sural arteries respectively.
2. The medial gastrocnemius flap is most commonly used due to its large size and reliable vascular pedicle. It can be raised as a muscle or musculocutaneous flap to cover defects of the upper leg and knee.
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Zygoma fractures
1) Fractures of the zygoma are commonly caused by road traffic accidents and assaults, with the left side more frequently involved than the right.
2) Classification systems categorize fractures based on the location and degree of displacement. Surgical approaches are determined by the fracture pattern and may involve extraoral or intraoral incisions.
3) Treatment involves closed or open reduction and fixation using methods like K-wires, plates and screws to properly align the zygomatic arch, frontal bone sutures, and orbital rim/floor. Complications can include sinusitis, malunion, diplopia or nerve numbness if not addressed correctly.
Wound healing (cutaneous)
Wound healing involves three overlapping phases: inflammatory, proliferative, and remodeling. In the inflammatory phase, fibrin and a provisional matrix form over the wound to prevent infection. In the proliferative phase, re-epithelialization occurs to regrow skin cells over the wound. Granulation tissue forms below the wound as new blood vessels and extracellular matrix develop. Collagen is deposited and remodeled. Finally, in the remodeling phase, collagen is reorganized and cross-linked to increase wound strength as it matures over 6-12 months. Factors like age, nutrition, smoking, and infection can impact wound healing.
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Contralateral c7 CC7 transfer
- 1. Contralateral C7 Transfer Dr. Satish Kumar.S MCh Plastic Surgery Final Year Resident
- 2. Introduction • Opposite side unaffected C7 brachial plexus nerve root is used to neurotize the nerves on the affected side by different routes and nerve grafts to achieve function on the affected side without compromising function in the normal side.
- 3. History • Shanghai Huashan Hospital in 1986 by Dr. Gu et al.
- 4. Indications • No available nerves in affected side • In total root avulsion, in addition to available nerves on affected site • When any neurotization fails
- 5. Why C7? • C7 innervated muscles are cross – innervated by C6, C8 roots • No significant loss of any muscle function
- 6. Decisions • Patient selection • Staged procedure • Single stage procedure • Which part of C7 to use • Which recipient nerve
- 7. Patient selection • Need of surgery in normal side • Effects of the surgery on the normal side • Need for second stage • Time delay for positive effects • Stress on strict PT and ES follow-up by pt
- 10. Vascularised Ulnar Nerve Graft • I/L ulnar nerve used as a pedicled graft • Based on Superior Ulnar Collateral artery (SUCA) • SUCA • - brachial artery – mid humeral level • 14-22 cm proximal to ME • Pierces IM septum • Posterior compartment > ulnar nerve • Accompanies nerve 4-15 cm • 3 arteria nervorum • Deep to FCU anastomosis – PURA & IUCA
- 15. Disadvantages • Sacrifice of ulnar nerve • Time delay of stages • Delay in growth of nerve (longer route)
- 16. Single stage • Direct co-aptation of CC7 to recipient nerve • Single procedure • Different routes
- 17. C.S. of neck
- 22. Other routes • Trans discal route • Trans carotid sheath route
- 23. Disadvantages • Extensive dissection of brachial plexus and normal neck anatomy • Shortening of humerus might be needed
- 24. Which part of C7 to use? • Complete C7 root – size mismatch • Anterior part - sensory • Posterior part - motor
- 25. Recipient nerve • Anterior div. Lower trunk – Wrist/Finger flexion • Posterior div. Lower trunk – Wrist/Finger extension • Median nerve • Radial nerve • MCN
- 26. Steps of Surgery – Stage I • Dissection of opposite side brachial plexus • Harvesting Vascularised Ulnar nerve Graft • Coaptation of VUNG to CC7 root
- 27. Delay for Stage II • Growth of nerve fascicles from CC7 into VUNG • Progress of Tinnel’s from CC7 root along path of VUNG upto axilla • 10-14 months
- 28. Steps of Surgery – Stage II • Division of loop of VUNG • Division of Recipient nerve • Coaptation of divided end of VUNG to recipient nerve
- 29. Incision
- 30. Follow up • After stage I • 3 weeks immobilization • Shoulder adduction, elbow extension exercise • Improve nerve growth • After stage II • 10-12 months for 1st movement to be noticed • Initiation of movement by healthy limb • Reinnervated muscles activated by adducting, internally rotating, extending C/L shoulder and extending C/L elbow
- 31. Complications • Temporary motor deficit • Shoulder extension, adduction, elbow extension, forearm pronation, wrist extension, hand movement • Temporary sensation loss in IF, MF • Full recovery – 6 months
- 32. THANK YOU