This document discusses nerve injury classification and techniques for nerve regeneration and repair. It describes two main classification systems - Seddon from 1943 and Sunderland from 1951. Seddon classified injuries as neuroprexia, axonotmesis, or neurotmesis. Sunderland's more detailed system classified injuries from 1st to 5th degree based on the anatomical structures disrupted. The document also discusses nerve degeneration, regeneration, diagnostic tests like nerve conduction studies and EMG, and techniques for nerve repair including neurolysis, neurorrhaphy, and nerve grafting.
This presentation is made to act as a guide and a short reminder to clinicians and medical students on Volkmann's Ischaemic Contracture, which is a medical condition that can lead to activities limitation and public participation restriction. This presentation explore aspects of the condition such as what it is, causes, how it can be diagnosed, how it can be managed and others.
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
Claw Hand,Definition,Causes,Types,Symptoms and ManagementDr.Md.Monsur Rahman
Dr.Md.Monsur Rahman, Bachelor of Physiotherapy (BPT), Master of Physiotherapy (MPT) in Musculoskeletal Disorders, ABC-Spine in Osteopathic Approach,
Maharishi Markandeshwar (Deemed to be University), Ambala -Haryana.
BELL'S PALSY IS AN IDIOPATHIC LMN TYPE FACIAL PALSY..THE SEMINAR TELLS YOU OF COURSE OF NERVE..FACIAL MUSCLES THEIR ACTION..HOW TO EXAMINE..THE SEQUELAE OF FACIAL PALSY...LOOK AT IT..
Brown sequard syndrome or transverse hemisection syndrome
Causes symptoms and treatment of brown sequard syndrome
Background about the disease
Neural tracts
Ascending and descending pathways of the spinal cord (motor and sensory pathways)
Pathophysiology of brown sequard syndrome
This presentation is made to act as a guide and a short reminder to clinicians and medical students on Volkmann's Ischaemic Contracture, which is a medical condition that can lead to activities limitation and public participation restriction. This presentation explore aspects of the condition such as what it is, causes, how it can be diagnosed, how it can be managed and others.
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
Claw Hand,Definition,Causes,Types,Symptoms and ManagementDr.Md.Monsur Rahman
Dr.Md.Monsur Rahman, Bachelor of Physiotherapy (BPT), Master of Physiotherapy (MPT) in Musculoskeletal Disorders, ABC-Spine in Osteopathic Approach,
Maharishi Markandeshwar (Deemed to be University), Ambala -Haryana.
BELL'S PALSY IS AN IDIOPATHIC LMN TYPE FACIAL PALSY..THE SEMINAR TELLS YOU OF COURSE OF NERVE..FACIAL MUSCLES THEIR ACTION..HOW TO EXAMINE..THE SEQUELAE OF FACIAL PALSY...LOOK AT IT..
Brown sequard syndrome or transverse hemisection syndrome
Causes symptoms and treatment of brown sequard syndrome
Background about the disease
Neural tracts
Ascending and descending pathways of the spinal cord (motor and sensory pathways)
Pathophysiology of brown sequard syndrome
Degeneration & regeneration of nerve fiber.ppt by Dr. PANDIAN M.Pandian M
INTRODUCTION
CLASSIFICATION OF NERVE INJURIES
INJURY OF THE NERVE CELL BODY
INJURY OF THE NERVE CELL PROCESS
CHANGES IN THE DISTAL SEGMENT OF THE AXON
CHANGES IN THE PROXIMAL SEGMENT OF THE AXON
CHANGES IN THE NERVE CELL BODY
RECOVERY OF THE NEURONS FOLLOWING INJURY
REGENERATION OF AXONS IN THE PERIPHERAL NERVES
REGENERATION OF AXONS IN THE CNS
Peripheral nerve injuries-ASSESSMENT AND TENDON TRANSFERS IN RADIAL NERVE PALSYsuchitra_gmc
A presentation to understand peripheral nerve injuries assessment, evaluation and management. Includes principles of tendon transfer and techniques of tendon transfer for radial nerve palsy. Also, post operative rehabilitation is included.
PNI with Relevant Anatomy, Etiology, Mechanism of Degenration and Regenration, Saddon's and Sunderland Classifications, Clinical symptoms and Examination (Tests) of Brachial Plexus, Radial & Median Nerve.
Nerve injury is an injury to nervous tissue. There is no single classification system that can describe all the many variations of nerve injuries. In 1941, Seddon introduced a classification of nerve injuries based on three main types of nerve fiber injury and whether there is continuity of the nerve.
Seddon2 classified nerve injuries into three broad categories; neurapraxia, axonotmesis, and neurotmesis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
4. CLASSIFICATION OF NERVE INJURY
• Two different classifications are being used to
describe the nerve injuries
1. Proposed by SEDDON in 1943
2. Proposed by SUNDERLAND in 1951
6. NEUROPRAXIA
• Minor contusion or compression of a
peripheral nerve with preservation of the axis-
cylinder but with possibly minor edema or
breakdown of a localized segment of myelin
sheath.
• Transmission of impulse is physiologically
interrupted for a period of time, but recovery
in a few days or weeks.
• Ex- Crutch palsy, Saturday night palsy
7. AXONOTMESIS
• More significant injury with breakdown of the
axon and distal wallerian degeration but with
preservation of the schwann cell and
endoneurial tubes.
• Spontaneous regeneration with good
functional recovery can be expected.
• It is usually the result of a more severe crush
or contusion than neuroprexia.
8. NEUROTMESIS
• Severe injury with complete anatomical
severance of the nerve or extensive avulsing
or crush injury.
• The axon, schwann cell and endoneurial tubes
are completely disrupted.
• In this group, significant spontaneous recovery
cannot be expected.
• It usually occurs in gunshot or knife injuries.
9.
10. SUNDERLAND’s CLASSIFICATION
• This is more rapidly applicable clinically, with
each degree of injury suggesting a greater
anatomical disruption with its correspondingly
altered prognosis.
• In this classification peripheral nerve injuries
are arranged in ascending order of severity.
• Anatomically various degrees represent injury
to 1)myelin 2)axon 3)endoneurial tube and its
contents 4)perineurium 5)entire nerve trunk.
11. 1st degree injury
• In this conduction the axon is physiologically
interrupted at the site of injury but the axon is
not disrupted.
• No wallerian degeneration.
• Recovery is spontaneous and usually complete
within a few days or weeks.
• Because there is neither axonal damage nor
regeneration, no Tinel sign is present.
12. 2nd degree injury
• Disruption of the axon is evident, with wallerian
degeneration distal to the point of injury and
proximal degeneration for one or more nodal
segments.
• Integrity of the endoneurial tube is maintained,
providing a perfect anatomical course for
regeneration.
• Tinel sign can be followed along the course of the
nerve usually at the rate of 1 inch per month,
tracing the progression of regeneration.
• Good functional return is achieved.
13. 3rd degree injury
• In this the axons and endoneurial tubes are
disrupted but the perineurium is preserved.
• The result is disorganization resulting from
disruption of the endoneurial tubes.
• Clinically, the neurological loss is complete in
most instances.
• Tinel sign is usually present.
• However complete return of neural function does
not occur, distinguishing this from 2nd degree
injury.
14. 4th degree injury
• In this the axon and endoneurium and
possibly some of the perineurium are
preserved, so complete severance of the
entire trunk does not occur.
• No Tinel sign.
• Prognosis for significant return of useful
function is uniformly poor without surgery.
15. 5th degree injury
• The nerve is completely transected, resulting
in a variable distance between the neural
stumps.
• Possibility of significant return of function
without appropriate surgery is very remote.
16. 6th degree injury
• Also called as Mackinnon or mixed injuries
occur in which nerve trunk is partially severed
and the remaining part of the trunk sustains,
4th degree, 3rd degree, 2nd degree, or rarely
even 1st degree injury.
• Recovery pattern is mixed depending on the
degree of injury to each portion of the nerve.
17. Nerve Degeneration
• Any part of a neuron detached from its
nucleus degenerates and is destroyed by
phagocytosis.
• This process of degeneration distal to a point
of injury is called secondary or wallerian
degenetarion.
• The reaction proximal to the point of
detachment is called primary, traumatic or
retrograde degeneration.
18. • 1st 3 days- macrophagic changes become
apparent in axon
• After 3 days – distal segment becomes
fragmented and with subsequent fluid loss the
fragments begin to shrink and assume a more
oval or globular appearance.
• By 7th day macrophages have reached the area in
greater numbers,
• By 15– 30 days clearing of axonal debris is
complete.
19.
20. Nerve regeneration
• The onest of regeneration is accompanied by
changes in the cell body
• CHROMATOLYSIS with swelling of the
cytoplasm and eccentric placement of the
nucleus.
• The reaction within the cell body is evident by
day 7 and evidence of beginning recovery is
apparent after 4-6 weeks.
21. • The proximal segment of the axon degenerates
close to the injury for a short distance, but
growth starts as soon as debris is removed by
macrophages.
• Macrophages produce cytokines which stimulate
Schwann cells.
• In the nerve segment distal to the injury the axon
and myelin are completely removed by the
macrophages but not the connective tissue.
22. • While these regressive changes take place,
Schwann cells proliferate within the
connective tissue sleeve, giving rise to rows of
cells that serve as guides for the sprouting
axons.
• Axonal sprouting may occur within 24hrs after
injury.
23. • Regeneration is successful only if the
endoneurial tube with its contained Schwann
cells has been uninterrupted by the injury, the
sprouts may pass readily along their former
courses and after regenertaion the surviving
cells innervate their previous end organs.
24. • If the injury is severe enough to interrupt the
endoneurial tube with its with its contained
Schwann cells, the sprouts may migrate
aimlessly throughout the damaged regions to
form stump NEUROMA.
26. Nerve conduction velocity
• A nerve conduction velocity test (NCV) is an
electrical test that is used to determine the
adequacy of the conduction of the nerve
impulse as it courses down a nerve. This test is
used to detect signs of nerve injury.
• Stimulation of a peripheral nerve by an
electrode placed on the skin overlying the
nerve readily evokes a response from the
muscle innervated by that nerve.
27. • This is useful shortly after an injury to provide
objective evidence of interference in nerve
conductivity but it is impossible to determine the
severity of the insult immediately after injury.
• Immediately after injury, stimulation proximal and
distal to the insult may elicit a normal response.
• As wallerian degeneration ensures within 5-10 days
there is progressive reduction in the amplitude and
alteration in the configuration of the evoked
potentials.
28.
29. EMG
• Electromyography (EMG) is a diagnostic
procedure to assess the health of muscles and
the nerve cells that control them (motor
neurons).
• Motor neurons transmit electrical signals that
cause muscles to contract. An EMG translates
these signals into graphs, sounds or numerical
values that a specialist interprets.
• An EMG uses tiny devices called electrodes to
transmit or detect electrical signals.
30. • During a needle EMG, a needle electrode inserted
directly into a muscle records the electrical
activity in that muscle.
• A nerve conduction study, another part of an
EMG, uses electrodes taped to the skin (surface
electrodes) to measure the speed and strength of
signals traveling between two or more points.
• EMG results can reveal nerve dysfunction, muscle
dysfunction or problems with nerve-to-muscle
signal transmission
31.
32. Tinel sign
• The Tinel sign is elicited by gentle percussion by a
finger or percussion hammer along the course of an
injured nerve.
• A transient tingling sensation should be felt by the
patient in the distribution of the injured nerve rather
than at the area percussed, and the sensation should
persist for several seconds after stimulation.
• A positive Tinel sign is presumptive evidence that
regenerating axonal sprouts that have not obtained
complete myelinization are progressing along the
endoneurial tube.
34. ENDONEUROLYSIS (INTERNAL
NEUROLYSIS).
• It is an enoneurial exploration for assesing the
injury of fasciculli.
• If most of the fasciculli are intact and can be
seperated and traced through the neuroma,
nothing further should be done.
• It stimulation fails to elicit a response, a few if
any intact fasciculli can be found, resecting the
neuroma and neurorraphy are probably
indicated.
37. EPINEURIAL NEURORRHAPHY
Expose the nerve and dissect the redundent areolar tissue from
epinuerium
Gently trim the nerve ends to identify good neural tissue and locate
fescicles
Using the internal arrangement of fascicles and the vessels on the
epinuerium determine the rotational arrangement
Place a 9-0 monofilament nylon suture through the epineurium and
tie this stitch
Place sutures circumferentially around the cut surface, attempting to
align appropriatly corresponding fascicles without suturing them.
38.
39. PERINEURIAL NEURORRHAPHY
• Same as Epineural Neurorrhaphy but in this
epineurium from the circumference surrounding
the groups of fascicles is also removed.
• Attempt is made to match corresponding groups
of fascicles proximally and distally.
• After this nerve is repaired by suturing the ends
of the fascicles together with atleast 2 sutures
placed through the perineurium at 180 degrees
to each other.
40.
41. EPIPERINEURIAL NEURORRHAPHY
• This includes epineurium and perineurium is
useful in aligning large groups of fascicles in
larger nerves and when nerves have been
incompletely transected.
• After aproximation of fascicles proximally and
distally repair individual fascicles in central
portion of nerve 1st by using 10-0 nylon suture
• Then approximate the fascicles and group of
fascicles that lie near the periphery of the nerve
by placing 9-0 nylon through the epineurium and
through the edge of the perineurium.
42.
43. • Post op care-
• The initial postoperative splinting is maintained for 3 weeks,
during which time the patient is allowed minimal active
movement of the finger joints within the limits of the splint.
• Suture removal done between 7-14th day.
• Four to 8 weeks after operation, removable plastic splints are
used in reliable patients.
• Six to 12 weeks after surgery, careful attention should be paid
to the avoidance of fixed contracture .
• Eight to 12 weeks after surgery, progressive strengthening
exercises are begun.
• Clinical evaluations of motor and sensory return are made
monthly
44. INTERFASCICULAR GRAFTING
• This comes under secondary neurorrhaphy
• Developed by MILLESI.
• He developed a technique of grafting using
multiple cuntaneous nerve grafts that allow
alignment of fascicles in proximal and distal
nerve stumps.
45. TECHNIQUE
Incise the epineurium proximal to the neuroma in normal appearing tissue on
the proximal stump and similarly towards the scared distal stump
Identify major fascicle groups and follow them to the scar.
Transect thin fascile group there with microscissors and prepare both ends
Select a graft, expose and dissect the nerve graft
Keep it moist with ringer solution
Using diamond knife cut the nerve graft into sections 10% - 15% longer than
the defect
46. Excise the redundent epineurial and areolar tissue from the graft
Place the nerve grafts between the proximal and distal nerve stumps
Use sketch of fascicles to determine where to attach the graft at each end
Obtain exact coaptation of the nerve graft to the corresponding fascicle
groups
Suture the nerve graft at each end using 10-0 nylon placed through the
epineurium of graft and perineurium of one of the fascicle group
Close the skin carefully so that graft is not displaced by shearing forces during
wound closure
48. Nerve grafts placed between nerve ends
Nerve grafts sutured in place
Technique of interfascicular nerve grafting
49. • Post op care-
• The part is immobilized for 8 to 10 days.
• Afterward the splint is removed, and free motion of
joints is allowed.
• Necrotic skin is debrided, and local flaps or free skin
grafts are used to cover a nerve graft that may be
exposed.
• Physical therapy with active and active-assisted range-
of-motion exercises is instituted under supervision 2
weeks after nerve grafting.
• The progress of regeneration may be followed by
observing the Tinel sign.