This document discusses the anatomy, classification, clinical features, investigations, and treatment techniques for peripheral nerve injuries. Some key points include:
- Peripheral nerves are composed of bundles of axons surrounded by connective tissue sheaths including the epineurium, perineurium, and endoneurium.
- Nerve injuries are classified based on the severity of damage, with neuropraxia having the best prognosis and neurotmesis having the worst.
- Treatment depends on the type and severity of injury, and may include non-operative management, primary repair, nerve grafting, nerve transfers, or the use of conduits.
- Prognosis is best when the injury
The document summarizes techniques for peripheral nerve repair. It describes nerve anatomy, types of nerve injuries including stretching, compression and laceration injuries. It discusses the process of nerve degeneration and regeneration after injury. Surgical techniques for nerve repair including epineurial and perineurial neurorrhaphy are outlined. Primary and secondary nerve repair indications and techniques are also covered.
This document discusses magnetic resonance imaging (MRI) for peripheral nerves. It begins by providing background on how MRI has become a standard imaging method for the central nervous system due to its soft tissue contrast. It then discusses some limitations of using MRI for peripheral nerves, including technical limitations of older scanners. The document outlines several clinical applications of peripheral nerve MRI, such as evaluating carpal tunnel syndrome, neural tumors, and traumatic nerve injuries. It describes the ability of MRI sequences like diffusion imaging to assess properties of neural tissue. The document concludes by discussing technical considerations for peripheral nerve MRI protocols and sequences.
The radial nerve provides motor innervation and sensory innervation to parts of the arm and forearm. Radial nerve injuries can occur due to fractures, lacerations, or compression neuropathies. Treatment depends on the level and severity of injury, and may involve nerve repair/grafting, tendon transfers, or splinting. Common tendon transfers include the palmaris longus to extensor pollicis longus, flexor carpi ulnaris to extensor digitorum communis, and pronator teres to extensor carpi radialis brevis. Postoperative splinting and rehabilitation are important after surgical treatment of radial nerve injuries.
The document discusses different types of nerve injuries - neurapraxia, axonotmesis, and neurotmesis. Neurapraxia involves intact axons and spontaneous recovery. Axonotmesis involves divided axons but intact connective tissue, resulting in Wallerian degeneration and slow regeneration. Neurotmesis is a complete nerve severing requiring surgical repair. The document also outlines approaches to surgical nerve repair, including direct suture and nerve grafting when a gap exists. Post-operation, the repair needs splinting and physiotherapy to aid recovery.
This document discusses the history and techniques of peripheral nerve repair. It notes that peripheral nerves have the ability to regenerate after injury, unlike the central nervous system. The key points covered include:
- The timeline of discoveries and advances in peripheral nerve repair from the 17th century to present day.
- The anatomy of peripheral nerves and the different layers (epineurium, perineurium, endoneurium)
- Grading systems for peripheral nerve injuries.
- Pre-operative evaluation techniques like nerve conduction studies and EMG.
- Surgical techniques for different types of injuries like transection, avulsion or neuroma in continuity.
- Microsurgical techniques like
This document summarizes peripheral nerve injury, including grading, mechanisms of injury and regeneration, management, and surgical techniques. It discusses:
- Grading of peripheral nerve injuries from neuropraxia to neurotmesis
- Factors that affect neuronal regeneration such as chronic denervation and misdirected growth
- Surgical management including direct repair, nerve grafts, nerve transfers, and secondary procedures
- Principles of peripheral nerve surgery including timing, coaptation techniques, and the use of growth factors or electrical stimulation to enhance regeneration
Broad frame work of management in peripheral nerveVenkat Jampana
This document outlines the management of peripheral nerve injuries. It discusses the initial assessment and treatment, as well as factors that influence recovery prognosis. Open injuries may be explored early, while closed injuries are monitored for signs of regeneration before potential surgery. Surgical techniques like nerve grafting and tendon transfers are described. Motor, sensory, reflex, autonomic, and trophic complications of peripheral nerve injuries are also summarized.
This document discusses peripheral nerve injuries, including their classification, clinical features, and treatment principles. It describes the structure of nerves and the process of nerve regeneration. There are three main types of nerve injuries: neuropraxia (mild nerve stretch or contusion), axonotmesis (more severe injury with axon disruption but intact nerve sheaths), and neurotmesis (complete nerve injury or transaction). The classification is based on the extent of nerve damage and prognosis varies accordingly. Clinical assessment involves determining the affected nerve, injury level, cause, and signs of recovery. Management principles involve exploration of open injuries, nerve repair techniques like suturing or grafting, and conservative measures like splinting and physiotherapy
The document summarizes techniques for peripheral nerve repair. It describes nerve anatomy, types of nerve injuries including stretching, compression and laceration injuries. It discusses the process of nerve degeneration and regeneration after injury. Surgical techniques for nerve repair including epineurial and perineurial neurorrhaphy are outlined. Primary and secondary nerve repair indications and techniques are also covered.
This document discusses magnetic resonance imaging (MRI) for peripheral nerves. It begins by providing background on how MRI has become a standard imaging method for the central nervous system due to its soft tissue contrast. It then discusses some limitations of using MRI for peripheral nerves, including technical limitations of older scanners. The document outlines several clinical applications of peripheral nerve MRI, such as evaluating carpal tunnel syndrome, neural tumors, and traumatic nerve injuries. It describes the ability of MRI sequences like diffusion imaging to assess properties of neural tissue. The document concludes by discussing technical considerations for peripheral nerve MRI protocols and sequences.
The radial nerve provides motor innervation and sensory innervation to parts of the arm and forearm. Radial nerve injuries can occur due to fractures, lacerations, or compression neuropathies. Treatment depends on the level and severity of injury, and may involve nerve repair/grafting, tendon transfers, or splinting. Common tendon transfers include the palmaris longus to extensor pollicis longus, flexor carpi ulnaris to extensor digitorum communis, and pronator teres to extensor carpi radialis brevis. Postoperative splinting and rehabilitation are important after surgical treatment of radial nerve injuries.
The document discusses different types of nerve injuries - neurapraxia, axonotmesis, and neurotmesis. Neurapraxia involves intact axons and spontaneous recovery. Axonotmesis involves divided axons but intact connective tissue, resulting in Wallerian degeneration and slow regeneration. Neurotmesis is a complete nerve severing requiring surgical repair. The document also outlines approaches to surgical nerve repair, including direct suture and nerve grafting when a gap exists. Post-operation, the repair needs splinting and physiotherapy to aid recovery.
This document discusses the history and techniques of peripheral nerve repair. It notes that peripheral nerves have the ability to regenerate after injury, unlike the central nervous system. The key points covered include:
- The timeline of discoveries and advances in peripheral nerve repair from the 17th century to present day.
- The anatomy of peripheral nerves and the different layers (epineurium, perineurium, endoneurium)
- Grading systems for peripheral nerve injuries.
- Pre-operative evaluation techniques like nerve conduction studies and EMG.
- Surgical techniques for different types of injuries like transection, avulsion or neuroma in continuity.
- Microsurgical techniques like
This document summarizes peripheral nerve injury, including grading, mechanisms of injury and regeneration, management, and surgical techniques. It discusses:
- Grading of peripheral nerve injuries from neuropraxia to neurotmesis
- Factors that affect neuronal regeneration such as chronic denervation and misdirected growth
- Surgical management including direct repair, nerve grafts, nerve transfers, and secondary procedures
- Principles of peripheral nerve surgery including timing, coaptation techniques, and the use of growth factors or electrical stimulation to enhance regeneration
Broad frame work of management in peripheral nerveVenkat Jampana
This document outlines the management of peripheral nerve injuries. It discusses the initial assessment and treatment, as well as factors that influence recovery prognosis. Open injuries may be explored early, while closed injuries are monitored for signs of regeneration before potential surgery. Surgical techniques like nerve grafting and tendon transfers are described. Motor, sensory, reflex, autonomic, and trophic complications of peripheral nerve injuries are also summarized.
This document discusses peripheral nerve injuries, including their classification, clinical features, and treatment principles. It describes the structure of nerves and the process of nerve regeneration. There are three main types of nerve injuries: neuropraxia (mild nerve stretch or contusion), axonotmesis (more severe injury with axon disruption but intact nerve sheaths), and neurotmesis (complete nerve injury or transaction). The classification is based on the extent of nerve damage and prognosis varies accordingly. Clinical assessment involves determining the affected nerve, injury level, cause, and signs of recovery. Management principles involve exploration of open injuries, nerve repair techniques like suturing or grafting, and conservative measures like splinting and physiotherapy
Entrapment Neuropathies document discusses various peripheral nerve entrapment syndromes, focusing on carpal tunnel syndrome and anterior interosseous nerve syndrome. It provides details on the anatomy, pathophysiology, clinical presentation, diagnostic studies including electrodiagnostic testing, differential diagnosis, and treatment options including splinting, injections, and surgical decompression for relieving nerve compression in these conditions. Surgical techniques for carpal tunnel release including open, limited open, and endoscopic methods are outlined, as well as potential complications.
This document summarizes an experimental study that evaluated prolonging nerve grafts using bioengineered muscle-in-vein scaffolds with a 'window-vein' method. The study used 30 rats divided into 3 groups: direct nerve coaptation; grafting with 2 x 1.5 cm muscle-in-vein grafts sutured together; and a single 3 cm muscle-in-vein graft using the 'window-vein' method with electromagnetic stimulation. Histological and functional analyses at 12 weeks found similar regeneration in the direct coaptation and 'window-vein' groups, but poorer results in the sutured graft group. The researchers concluded that the 'window-vein'
Nerve Injuries and its management techniues.pptxHanineHassan2
This document discusses nerve injury classification and techniques for nerve repair. It describes Seddon and Sunderland's classifications of nerve injuries based on the extent of axon and nerve structure disruption. Nerve degeneration and regeneration processes are also outlined. The document then explains diagnostic tests like nerve conduction studies and electromyography. Finally, it provides details on techniques for nerve repair through neurorrhaphy, nerve grafting, and interfascicular grafting.
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.
This document provides an overview of peripheral nerve injury, including:
- The anatomy of peripheral nerves and some major nerves of the upper and lower limbs.
- Types of peripheral nerve injuries according to Seddon's classification including neurapraxia, axonotmesis, and neurotmesis.
- Common causes of peripheral nerve injury like laceration, bruising, or stretching.
- Clinical presentations vary depending on the type of injury but can include muscle weakness, sensory disturbances, and loss of function distal to the injury site.
- Diagnosis involves physical exam, neurological exam, and electrodiagnostic testing like EMG and NCV.
- PT management focuses on pain relief, range of motion, muscle
Treatment Options for Brachial Plexus Injuries by PIK.pptxputufristy
Treatment options for brachial plexus injuries include conservative treatment like pain management and rehabilitation or surgical options. Surgical treatments include neurolysis to remove scar tissue, nerve grafting to bridge nerve gaps, and nerve transfers to reinnervate paralyzed muscles. Tendon transfers and muscle flaps can also help restore function. The goal is to restore elbow flexion first and then other motions like shoulder stability and abduction. Advances in microsurgery have improved surgical reconstruction outcomes.
The myotendinous junction (MTJ) is the region where muscle fibers connect to tendons. It features finger-like projections called digitations that increase the surface area for force transmission. Each skeletal muscle receives innervation from a motor nerve for contraction and sensory fibers for proprioception. The neuromuscular junction is the synapse between the motor neuron and muscle fiber, where the neurotransmitter acetylcholine is released to trigger muscle fiber depolarization and contraction.
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 document provides information about radial nerve palsy and peripheral nerve injury classification. It discusses:
- The anatomy of peripheral nerves and how they can be injured through ischemia, compression, traction, laceration or burning.
- A classification system for nerve injuries from neuropraxia (reversible conduction block) to axonotmesis (axon interruption but nerve continuity) to neuronotmesis (nerve trunk division).
- Clinical signs of nerve injury like numbness, muscle weakness, and abnormal posture. Electrodiagnostic studies and tests like the Tinel's sign that can help assess nerve recovery are also outlined.
This document summarizes a seminar on median nerve injury. It begins with an anatomy overview of peripheral nerves, brachial plexus, and the median nerve. It then discusses causes of median nerve injury including trauma, leprosy, poliomyelitis, and carpal tunnel syndrome. Symptoms and examination findings of median nerve injury and carpal tunnel syndrome are provided. The document concludes with an overview of nerve repair techniques including epineural repair, interfascicular repair, and nerve grafting.
This document summarizes a seminar on median nerve injury. It begins with an anatomy overview of peripheral nerves, brachial plexus, and the median nerve. It then discusses causes of median nerve injury including trauma, leprosy, poliomyelitis, and carpal tunnel syndrome. Symptoms and examination findings of median nerve injury and carpal tunnel syndrome are provided. The document concludes with an overview of nerve repair techniques including epineural repair, interfascicular repair, and nerve grafting.
This document discusses the anatomy and classification of peripheral nerve injuries. It begins by describing the cellular components of nerves, types of nerve fibers, and classifications of nerve injuries including Seddon's and Sunderland's. It then discusses signs and symptoms of nerve injuries, common sites of injury, Wallerian degeneration, nerve regeneration, and various surgical and non-surgical treatment options including neurolysis, nerve grafting, and nerve repair. Classification of injuries is based on damage to nerve components and ability for spontaneous recovery. Surgical treatment depends on the degree and severity of injury.
Nerve compression syndrome, also known as entrapment neuropathy, occurs when a peripheral nerve is compressed, causing mechanical damage. Carpal tunnel syndrome is a common example, where the median nerve is compressed as it passes through the carpal tunnel in the wrist. Symptoms include tingling, numbness, and pain in the fingers innervated by the median nerve that is worsened at night. Physical exams and tests like Phalen's maneuver, Tinel's sign, and nerve conduction studies can help diagnose CTS. Treatment involves splinting, medications, injections, or carpal tunnel release surgery if conservative measures fail.
The document provides information about the radial nerve including its anatomy, course, branches and clinical presentations of radial nerve palsies. It discusses the radial nerve's origin from the brachial plexus and branches in the arm and forearm. Common causes of radial nerve palsy include fractures and entrapment in the radial tunnel. Clinical features, investigations, treatment including splinting and tendon transfers, and postoperative management are outlined. Surgical techniques for nerve repair and reconstructive procedures are also described.
This document provides an overview of peripheral nerve injuries. It begins with the anatomy and classification of peripheral nerves. There are three main types of peripheral nerve injuries classified by Seddon: neuropraxia, axonotmesis, and neurotmesis. The document then discusses the various modes of peripheral nerve injury including stretch, laceration, compression, and ischemia. Specific peripheral nerves of the upper and lower limb that are commonly injured are then reviewed, along with their typical causes, symptoms, and treatment approaches.
The document discusses the neuromuscular junction (NMJ), which is the synapse between a motor neuron and muscle fiber that converts electrical signals from the neuron into muscle activity. It describes the structure of the NMJ including the motor endplate and synaptic cleft. Events of neuromuscular transmission such as acetylcholine release and destruction are summarized. The document also discusses myasthenia gravis, an autoimmune disease caused by antibodies against acetylcholine receptors, and its symptoms and treatment with cholinesterase inhibitors.
This document discusses various techniques for peripheral nerve blocks, including blocks of the brachial plexus and individual nerves of the upper extremity. It provides details on the anatomy of the brachial plexus and surrounding structures. Several approaches for brachial plexus blocks are described, including interscalene, supraclavicular, infraclavicular, and axillary blocks. Each approach is outlined, including indications, technique, potential complications, and side effects. Proper patient positioning, needle placement, and administration of local anesthetic are emphasized.
This document discusses the pathology and management of malignant bowel obstruction. It defines malignant bowel obstruction as luminal narrowing of the small or large bowel due to metastatic cancer. The most common primary cancers causing MBO are colorectal, ovarian, stomach, and pancreatic cancers. The document outlines the classification, signs and symptoms, diagnostic tests including CT scan, and various treatment options for MBO, including surgical resection, endoscopic stenting, non-operative management with medications like octreotide to relieve symptoms, and palliative care since MBO represents terminal cancer. The primary goals of treatment are palliation to improve quality of life by relieving nausea, vomiting and pain.
- Malignant melanoma is a deadly form of skin cancer that has been increasing in incidence over the past 50 years.
- It typically presents as an asymmetric mole with irregular borders and varies in color.
- Risk factors include family history, numerous moles, sun exposure, and fair skin.
- Staging involves evaluating tumor thickness and spread. Treatment may include surgery, lymph node assessment, radiation, immunotherapy, and targeted drug therapy. Prognosis depends on stage, with thinner tumors having better survival rates.
Entrapment Neuropathies document discusses various peripheral nerve entrapment syndromes, focusing on carpal tunnel syndrome and anterior interosseous nerve syndrome. It provides details on the anatomy, pathophysiology, clinical presentation, diagnostic studies including electrodiagnostic testing, differential diagnosis, and treatment options including splinting, injections, and surgical decompression for relieving nerve compression in these conditions. Surgical techniques for carpal tunnel release including open, limited open, and endoscopic methods are outlined, as well as potential complications.
This document summarizes an experimental study that evaluated prolonging nerve grafts using bioengineered muscle-in-vein scaffolds with a 'window-vein' method. The study used 30 rats divided into 3 groups: direct nerve coaptation; grafting with 2 x 1.5 cm muscle-in-vein grafts sutured together; and a single 3 cm muscle-in-vein graft using the 'window-vein' method with electromagnetic stimulation. Histological and functional analyses at 12 weeks found similar regeneration in the direct coaptation and 'window-vein' groups, but poorer results in the sutured graft group. The researchers concluded that the 'window-vein'
Nerve Injuries and its management techniues.pptxHanineHassan2
This document discusses nerve injury classification and techniques for nerve repair. It describes Seddon and Sunderland's classifications of nerve injuries based on the extent of axon and nerve structure disruption. Nerve degeneration and regeneration processes are also outlined. The document then explains diagnostic tests like nerve conduction studies and electromyography. Finally, it provides details on techniques for nerve repair through neurorrhaphy, nerve grafting, and interfascicular grafting.
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.
This document provides an overview of peripheral nerve injury, including:
- The anatomy of peripheral nerves and some major nerves of the upper and lower limbs.
- Types of peripheral nerve injuries according to Seddon's classification including neurapraxia, axonotmesis, and neurotmesis.
- Common causes of peripheral nerve injury like laceration, bruising, or stretching.
- Clinical presentations vary depending on the type of injury but can include muscle weakness, sensory disturbances, and loss of function distal to the injury site.
- Diagnosis involves physical exam, neurological exam, and electrodiagnostic testing like EMG and NCV.
- PT management focuses on pain relief, range of motion, muscle
Treatment Options for Brachial Plexus Injuries by PIK.pptxputufristy
Treatment options for brachial plexus injuries include conservative treatment like pain management and rehabilitation or surgical options. Surgical treatments include neurolysis to remove scar tissue, nerve grafting to bridge nerve gaps, and nerve transfers to reinnervate paralyzed muscles. Tendon transfers and muscle flaps can also help restore function. The goal is to restore elbow flexion first and then other motions like shoulder stability and abduction. Advances in microsurgery have improved surgical reconstruction outcomes.
The myotendinous junction (MTJ) is the region where muscle fibers connect to tendons. It features finger-like projections called digitations that increase the surface area for force transmission. Each skeletal muscle receives innervation from a motor nerve for contraction and sensory fibers for proprioception. The neuromuscular junction is the synapse between the motor neuron and muscle fiber, where the neurotransmitter acetylcholine is released to trigger muscle fiber depolarization and contraction.
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 document provides information about radial nerve palsy and peripheral nerve injury classification. It discusses:
- The anatomy of peripheral nerves and how they can be injured through ischemia, compression, traction, laceration or burning.
- A classification system for nerve injuries from neuropraxia (reversible conduction block) to axonotmesis (axon interruption but nerve continuity) to neuronotmesis (nerve trunk division).
- Clinical signs of nerve injury like numbness, muscle weakness, and abnormal posture. Electrodiagnostic studies and tests like the Tinel's sign that can help assess nerve recovery are also outlined.
This document summarizes a seminar on median nerve injury. It begins with an anatomy overview of peripheral nerves, brachial plexus, and the median nerve. It then discusses causes of median nerve injury including trauma, leprosy, poliomyelitis, and carpal tunnel syndrome. Symptoms and examination findings of median nerve injury and carpal tunnel syndrome are provided. The document concludes with an overview of nerve repair techniques including epineural repair, interfascicular repair, and nerve grafting.
This document summarizes a seminar on median nerve injury. It begins with an anatomy overview of peripheral nerves, brachial plexus, and the median nerve. It then discusses causes of median nerve injury including trauma, leprosy, poliomyelitis, and carpal tunnel syndrome. Symptoms and examination findings of median nerve injury and carpal tunnel syndrome are provided. The document concludes with an overview of nerve repair techniques including epineural repair, interfascicular repair, and nerve grafting.
This document discusses the anatomy and classification of peripheral nerve injuries. It begins by describing the cellular components of nerves, types of nerve fibers, and classifications of nerve injuries including Seddon's and Sunderland's. It then discusses signs and symptoms of nerve injuries, common sites of injury, Wallerian degeneration, nerve regeneration, and various surgical and non-surgical treatment options including neurolysis, nerve grafting, and nerve repair. Classification of injuries is based on damage to nerve components and ability for spontaneous recovery. Surgical treatment depends on the degree and severity of injury.
Nerve compression syndrome, also known as entrapment neuropathy, occurs when a peripheral nerve is compressed, causing mechanical damage. Carpal tunnel syndrome is a common example, where the median nerve is compressed as it passes through the carpal tunnel in the wrist. Symptoms include tingling, numbness, and pain in the fingers innervated by the median nerve that is worsened at night. Physical exams and tests like Phalen's maneuver, Tinel's sign, and nerve conduction studies can help diagnose CTS. Treatment involves splinting, medications, injections, or carpal tunnel release surgery if conservative measures fail.
The document provides information about the radial nerve including its anatomy, course, branches and clinical presentations of radial nerve palsies. It discusses the radial nerve's origin from the brachial plexus and branches in the arm and forearm. Common causes of radial nerve palsy include fractures and entrapment in the radial tunnel. Clinical features, investigations, treatment including splinting and tendon transfers, and postoperative management are outlined. Surgical techniques for nerve repair and reconstructive procedures are also described.
This document provides an overview of peripheral nerve injuries. It begins with the anatomy and classification of peripheral nerves. There are three main types of peripheral nerve injuries classified by Seddon: neuropraxia, axonotmesis, and neurotmesis. The document then discusses the various modes of peripheral nerve injury including stretch, laceration, compression, and ischemia. Specific peripheral nerves of the upper and lower limb that are commonly injured are then reviewed, along with their typical causes, symptoms, and treatment approaches.
The document discusses the neuromuscular junction (NMJ), which is the synapse between a motor neuron and muscle fiber that converts electrical signals from the neuron into muscle activity. It describes the structure of the NMJ including the motor endplate and synaptic cleft. Events of neuromuscular transmission such as acetylcholine release and destruction are summarized. The document also discusses myasthenia gravis, an autoimmune disease caused by antibodies against acetylcholine receptors, and its symptoms and treatment with cholinesterase inhibitors.
This document discusses various techniques for peripheral nerve blocks, including blocks of the brachial plexus and individual nerves of the upper extremity. It provides details on the anatomy of the brachial plexus and surrounding structures. Several approaches for brachial plexus blocks are described, including interscalene, supraclavicular, infraclavicular, and axillary blocks. Each approach is outlined, including indications, technique, potential complications, and side effects. Proper patient positioning, needle placement, and administration of local anesthetic are emphasized.
This document discusses the pathology and management of malignant bowel obstruction. It defines malignant bowel obstruction as luminal narrowing of the small or large bowel due to metastatic cancer. The most common primary cancers causing MBO are colorectal, ovarian, stomach, and pancreatic cancers. The document outlines the classification, signs and symptoms, diagnostic tests including CT scan, and various treatment options for MBO, including surgical resection, endoscopic stenting, non-operative management with medications like octreotide to relieve symptoms, and palliative care since MBO represents terminal cancer. The primary goals of treatment are palliation to improve quality of life by relieving nausea, vomiting and pain.
- Malignant melanoma is a deadly form of skin cancer that has been increasing in incidence over the past 50 years.
- It typically presents as an asymmetric mole with irregular borders and varies in color.
- Risk factors include family history, numerous moles, sun exposure, and fair skin.
- Staging involves evaluating tumor thickness and spread. Treatment may include surgery, lymph node assessment, radiation, immunotherapy, and targeted drug therapy. Prognosis depends on stage, with thinner tumors having better survival rates.
This document provides an overview of principles of management of burns. It defines burns and discusses epidemiology, anatomy of the skin, pathology and pathophysiology of burns. It also covers classification of burns by depth and extent, management including fluid resuscitation, wound dressings, surgery, pain management and infection control. Specific management of electrical burns is also discussed.
Antibiotics are antimicrobial substances that are used to treat and prevent infections in surgery. There are several principles for the appropriate use of antibiotics including selecting antibiotics based on the likely pathogen, using the narrowest spectrum antibiotic when possible, and administering antibiotics at the proper dose and duration. Antibiotics can be used prophylactically before surgery to prevent infection or therapeutically to treat an established infection, and the choice is guided by clinical diagnosis, culture results when available, and the urgency of the situation. Indiscriminate antibiotic use can promote resistance and should be avoided.
This document provides an overview of principles of cancer chemotherapy. It defines key terms and outlines the goals of chemotherapy as curative or palliative. The cell cycle is described and how different classes of chemotherapeutic agents work at specific phases. Principles of chemotherapy administration include pre-assessment, counseling, modality selection, dose optimization, administration procedures, management of side effects and follow up. Common drug classes and regimens are mentioned along with mechanisms of drug resistance and future trends in chemotherapy.
PRINCIPLES OF ORGAN TRANSPLANTATION 2003.pptOlofin Kayode
The document provides an overview of principles of transplant surgery. It defines different types of transplants including autotransplants, allotransplants, and xenotransplants. It discusses the history of transplantation, basic immunology including HLA antigens and allo-graft rejection. It also covers clinical immunosuppression with drugs like corticosteroids and cyclosporin. Organ procurement, specific organ transplants, and future trends are briefly mentioned.
The document discusses surgical haemostasis, which is the process of preventing or stopping blood loss from injured blood vessels during or after surgery. It defines haemostasis and outlines its importance in surgery. The physiology of haemostasis is described, involving vasoconstriction, platelet plug formation, and coagulation/fibrin formation. Causes of bleeding during or after surgery are discussed, including defects in haemostasis or platelet function. Methods of achieving haemostasis are covered, such as mechanical techniques like pressure, sutures, and cauterization, as well as chemical agents, blood products, and thermal techniques. Management of haemostasis in the pre-operative, intra-operative, and post-operative periods
Principle of Organ Transplantation.pptxOlofin Kayode
The document provides an overview of organ transplantation, including:
- Definitions of different types of organ transplants such as allografts and xenografts.
- A historical background of major transplant milestones from the 1950s onward including the first successful kidney, liver, lung, and heart transplants.
- Details about transplant immunology, the immune response to foreign organs, and ways to suppress the immune system like with immunosuppressant drugs.
- The types of organ rejection such as hyperacute, acute, and chronic rejection.
- Considerations for organ donation, procurement, preservation, and transplantation.
- Complications after transplantation like infection and potential future directions.
Principles of cancer chemotherapy(1).pptxOlofin Kayode
This document provides an overview of principles of cancer chemotherapy. It defines key terms and outlines the goals of chemotherapy as curative or palliative. The cell cycle is described and how different classes of chemotherapeutic agents work at specific phases. Principles of chemotherapy administration include pre-assessment, counseling, modality selection, dose optimization, administration procedures, management of side effects and follow up. Common drug classes and regimens are mentioned along with mechanisms of drug resistance and future trends in chemotherapy.
This document provides an overview of surgical site infections (SSIs). It defines SSIs and related terms like colonization and contamination. It discusses the historical context, epidemiology, classification, pathogenesis, clinical features, and factors that influence SSIs. The document also covers prevention strategies like proper patient preparation, aseptic technique, and antibiotic prophylaxis. It describes approaches for clinical assessment, wound scoring systems, and management of SSIs.
This document outlines the process and importance of preanesthetic evaluation. It defines preanesthetic evaluation as a medical check-up and lab tests done before surgery to assess patient health and risks. The evaluation aims to optimize patient preparation, ensure surgery is realistic, and anticipate problems. It involves taking a medical history, examining the patient, ordering relevant tests, and developing a preoperative plan. Factors like ASA grade and POSSUM score can help predict perioperative risks. The evaluation helps educate patients, organize care, and plan anesthesia to improve surgical outcomes.
The document discusses the metabolic response to trauma, which refers to adaptive changes that maintain homeostasis after injury. It outlines the triggers, components, and sequelae of the metabolic response. The components include sympathetic nervous system activation, endocrine responses like increased cortisol and growth hormone, and cytokine responses from interleukins and tumor necrosis factor. Prolonged or accentuated metabolic responses can harm surgical patients by increasing energy needs, reducing immunity, and impairing wound healing. The response can be attenuated by measures like fluid replacement, analgesia, nutritional support, and prompt infection treatment.
This document provides an overview of sepsis and septic shock, including definitions, epidemiology, pathogenesis, clinical features, investigation, treatment, complications, and prognosis. It defines sepsis as infection plus SIRS, and septic shock as sepsis that is not responsive to fluid resuscitation and requires vasopressors. The pathogenesis involves an initial inflammatory response to infection that can become dysregulated and lead to organ dysfunction. Treatment involves prompt resuscitation, antibiotics, source control, and organ support. Outcomes depend on factors like age, immune status, pathogen, and need for prolonged vasopressor support.
Day case surgery, also known as ambulatory surgery, involves planned admission and discharge of a patient within 12 hours for a surgical procedure. It provides several benefits over traditional inpatient surgery such as shorter hospital stays, lower infection rates, and more efficient use of healthcare resources. Common procedures performed as day cases include hernia repairs, cataract removal, and tonsillectomies. Careful patient selection and optimization, as well as coordinated perioperative management involving preoperative assessment and education, regional anesthesia when possible, early mobilization and feeding, and established discharge criteria are important for success. Day case surgery allows for treatment of more patients while maintaining high quality care.
This document provides an overview of deep vein thrombosis (DVT) and pulmonary embolism (PE). It covers the definition, epidemiology, risk factors, clinical features, investigations, management including prevention, treatment and anticoagulation. DVT occurs when a blood clot forms in a deep vein, usually in the legs, while PE is a complication that can occur when part of the clot breaks off and travels to the lungs. The document outlines Virchow's triad of factors that contribute to clot formation and discusses various diagnostic tests and therapeutic approaches for DVT and PE.
Fluid and Electrolyte Management in Surgery.pptOlofin Kayode
This document provides an outline and introduction to fluid and electrolyte management in surgery. It discusses the normal distribution and balance of body water and electrolytes like sodium, potassium, calcium and magnesium. It describes various fluid and electrolyte disorders that can occur including volume disturbances, concentration disturbances and composition disturbances. It covers causes, clinical features and treatment of conditions like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia and acid-base imbalances. The document emphasizes the importance of fluid and electrolyte management in the perioperative care of surgical patients.
This document discusses pain from multiple perspectives:
- It defines pain and provides a brief history of pain theories.
- Pain is classified and the physiology of pain transmission is explained through multiple stages from nociception to perception.
- Different types of pain like acute, chronic, neuropathic, and referred pain are described.
- Pain assessment and various scales used to evaluate pain are outlined.
- Non-pharmacological and pharmacological management of pain are summarized.
The document discusses nutrition in surgery, outlining relevant physiology, basic nutrient requirements, causes of malnutrition, nutritional assessment techniques, energy requirements, indications for nutritional support, and methods of enteral and parenteral nutrition to correct deficiencies and support patients during and after surgery. Nutritional support can help reduce complications from malnutrition like impaired wound healing and increased risk of infection.
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...Donc Test
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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2. Introduction
Anatomy of the nerve
Nerve injuries
Classification of nerve injuries
Clinical features
Investigations
Treatment
Techniques of nerve repair
Follow up
Complications
Prognosis
Conclusion
30/10/2023 2
3. Paulus Aegineta: 1ST to repair nerve in 17th century
others Rhazes, Evicenna
Repair was not attempted again until mid 19th
century
Nerves were thought not to regenerate or may cause
convulsion
Techniques refined following world war 1
Seddon & Woodhall further defined several methods
of repair during world war 2
Nerve repair was refined by Millesi with the
introduction of the operating microscope and
nerve improved staining technique.
30/10/2023 3
4. The term “Nerve” is often used erroneously to
describe what in fact is a bundle of nerve fibers.
The actual nerve fiber or axon is an anatomic
process of a single nerve cell.
Nerve fiber is the functional component of
peripheral nerve responsible for transmitting
stimuli.
The Axon is an extension of a neuron and can be
characterized by morphology, conduction velocity
and function
30/10/2023 4
5. FIGURE 1. Schematic drawing of a peripheral
nerve.
30/10/2023 5
FIGURE 1. Schematic drawing of a peripheral nerve.
6. Nerve
Nerves are solid white cords made up of bundles
of axons. Each nerve fibre is known as an axon
and each axon is bound together by fibrous tissue
into small bundles.
30/10/2023 6
7. Axon
An axon is a direct extension of a cell body. The
most important component of the peripheral nerve
is the nerve fibre that transmits the stimuli.
All other components of the nerve simply provide
the optimal conditions for the nerve fibre to
function.
30/10/2023 7
8. Nerve morphology
The nerve trunk is
composed of four
connective tissue
sheath. They are as
follows from outside
inward,
◦ Mesoneurium
◦ Epineurium
◦ Perineurium
◦ Endoneurium
30/10/2023 8
9. Mesoneurium
Is a connective tissue sheath that suspends the
nerve trunk within the soft tissue, contains the
segmental blood supply of the nerve and is
continuous with the second layer – the epineurium.
Epineurium
Is the loose connective tissue sheath that defines
the nerve trunk and protects it against mechanical
stress.
Composed of longitudinally oriented collagen fibres
that resist both compressive forces and stretch.
Nerve trunks are fairly mobile except where
branches and blood vessels enter the epineural
sheath.
30/10/2023 9
10. Perineurium
•It delineates the fascicles. In a living nerve, it is
a white glistening layer devoid of blood vessels.
•This is a continuation of the pia-arachnoid
mater of the central nervous system.
•It is composed of two layers
•Blood vessels transverse the perineurium to
connect the vasa nervosum and endoneurial
capillaries.
30/10/2023 10
11. Endoneurium
•It surrounds the individual nerve fibre and their
schwann cells.
•Endoneurium and perineurium together give
elasticity to the nerve.
•Endoneurium is composed of two layers
•The capillaries of the endoneurial space are
connected to vasa nervosum through the
perineurium.
30/10/2023 11
12. Each individual nerve fibre and their Schwann
cell are surrounded by endoneurium.
Group of nerve fibres – fasciculi
Each fasciculi is surrounded by perineurium
Group of fasciculi forms a nerve trunk
Fascicules are surrounded by epineurium.
30/10/2023 12
13. Etiology of peripheral nerve injuries
• Metabolic or collagen diseases.
• Malignancies.
• Endogenous or exogenous toxins.
• Thermal, mechanical or chemical injuries.
30/10/2023 13
14. • Mechanical injuries to peripheral nerves are most
common.
• Among this lacerating wounds resulting from road
traffic accidents, interpersonal violence including
stabs, war injuries such as bullet injuries are more
common.
• Iatrogenic nerve injuries are very common in
maxillofacial region.
30/10/2023 14
22. Always test for nerve injuries following any
significant trauma.
numbness,
paraesthesia
abnormal posture (e.g. a wrist drop in radial
nerve palsy),
weakness in specific muscle groups and
changes in sensibility.
Dry skin
30/10/2023 22
23. • Smooth and shiny
• Evidence of diminished sensibility such as
cigarette burns of the thumb in median nerve
palsy or foot ulcers with sciatic nerve palsy
30/10/2023 23
24. Diagnostic Tests/Assessment Of Nerve Recovery
History
• Nerve conduction studies ( NCS )
• Electromyography ( EMG )
They demonstrate fibrillations and denervation
potential in a completely denervated muscle
They help find the presence, location, and extent
of damage done to the nerves and muscles.
They distinguish neuropraxia from neurotmesis.
30/10/2023 24
25. A nerve conduction study
(NCS)— also called a
nerve conduction velocity
(NCV) test.
measures how fast an
electrical impulse moves
through the nerve using
percutaneous current to
stimulate the nerve
NCV can identify nerve
damage.
30/10/2023 25
26. Electromyography (
EMG )
• A resting muscle is
normally electrically
silent
• Records the
depolarization
potential of active
muscle movement
30/10/2023 26
27. • Muscle distal to injury may appear normal for
several days after injury(14 to 21 days) ,hence in
root avulsion the result is not reliable until after 3
wks when Wallerian degeneration in the post-
ganlionic lesion will block the nerve conduction.
• Best time for EMG is 3 to 4 wks post injury
30/10/2023 27
28. Tinel test:
◦ peripheral tingling or dysaesthesia provoked by
percussing the nerve – is important.
◦ In a neurapraxia, it is negative.
◦ In axonotmesis, it is positive at the site of injury
because of sensitivity of the regenerating axon
sprouts.
30/10/2023 28
29. Assessment of nerve function
◦ Two-point discrimination
◦ Threshood test
◦ Locognosia
◦ Moberg pick-up test
◦ Motor power
30/10/2023 29
30. Short inversion recovery MRI
A unique form of MRI that returns
pictures that can highlight nerve trauma.
Not as sensitive as NCS
Indications
1. Px wt non classic or ambiguous findings
e.g Dm
2. To visualize neuromas
3. To determine the length of damaged nerve
30/10/2023 30
31. MRI: shows ganglion, lipoma or bone spurs
in osseofibrous tunnel
CT myelography :
◦ Pseudomenigocele in brachial plexus inj.
◦ May show leakage of contrast medium
Doppler study: A- V fistular or aneurism
may cause nerve compression
X-ray: fracture or dislocation, may show
bone fragment in soft tissue
30/10/2023 31
32. Intradermal inj of histamine:
◦ If flare persists in an anaesthetic skin, suspect root
avulsion
Williams test; if immersed in water at 40
deg, normally innervated skin wrinkles
witthin 4 mins
30/10/2023 32
34. Choice of treatment depend on complete
patient assessment.
Treatment options includes
Non-operative
Operative
30/10/2023 34
35. Non-operative.
When awaiting for spontaneous recovery in
a close low energy injury
While waiting
Wound care
Physiotherapy
Dynamic splint
Opt for operative rx if no spontaneous
response in 3 mths
30/10/2023 35
36. Associated injuries should be managed before nerve
is repaired
Nerve must be handled gently
Operating microscope is ideal for nerve repair
Nerve exploration indications
• If nerve is seen to be divided and needs to be
repaired
• If type of injury (e.g. a knife wound or a high
energy injury) suggests that the nerve has been
divided or severely damaged
• If recovery is inappropriately delayed and the
diagnosis is in doubt.
30/10/2023 36
37. Primary repair
Divided nerve is best repaired ASAP
Prerequisites :
• Sharply incised nerve
• Minimal wound contamination
• No skeletal instability
• Patient is medically stable
• Facility is available
30/10/2023 37
38. Nerve is approximated end to end using 10/0
suture tension-free
Sufficient relaxation of soft tissue
Ensure homeostasis before closing the
wound.
Wound is splinted for 2-3 wks
Physiotherapy.
30/10/2023 38
39. Delayed repair
Indication;
• Close wound without sign of recovery after
3mths
• Diagnosis missed and patient present late
• Failed primary repair.
Excision is done if the neuroma is hard and
there is no conduction on nerve stimulation.
Stump sutured end to end tension-free
Splint application for 4 to 6 wks
30/10/2023 39
40. Nerve grafting
Free autogenous nerve grafts can be used
to bridge gaps too large for direct suture.
The sural nerve is most commonly used; up
to 40 cm can be obtained from each leg.
Graft is routed through a vascular bed.
A vascularised graft is used in special
situation like Volkmann ischemic
contracture.
30/10/2023 40
41. nerves require only one.
FIGURE 6. Sural nerve that is being used as a
cable graft to reconstruct a 6-cm defect in
the median nerve. The distal end of the nerve
graft is attached to the proximal nerve
stump.
30/10/2023 41
nerves require only one.
42. Nerve conduits
Prevents mechanical block
Provides suitable environment in which
neurotropic hormones can operate.
Maximum gap for conduit is 3cm
The inner diameter should be 30% >nerve
Indications:
Gap too big for end-to-end repair
Desire to achieve improved functional
outcome
To secure nerve ends pending definitive
repair.
30/10/2023 42
45. Nerve transfer
• Scarifying less important function to restore
a function of greater significance
• Root avulsion of upper Brachial plexus too
proximal for direct repair e.g. Spinal
accessory nerve to suprascaular nerve,
intercostal nerve to musculocutaneous nerve
30/10/2023 45
46.
Surg Can appx Vascular
bed
Prox end
intact
Distal
end
intact
End – end Yes Yes Yes Yes
Nerve
graft
No Yes Yes Yes
Vascular
graft
No No Yes Yes
Conduit No No Yes Yes
Nerve
transfer
No No No Yes
30/10/2023 46
47. Epineural repair
• Most commonly used
• End to end epineural repair done under
magnification with the nerve fascicles
aligned
• Use size 11 scalpel blade in trimming of
nerve ends
• Stitch pierces the epineurium
• Repair not under tension
• Repair should not violate the fascicles
30/10/2023 47
48. FIGURE 4. Drawing of a suture that is being
placed in an epineurial end-to-end repair.
The first stitch should be placed to align the
corresponding anatomic landmarks, such as
longitudinal landmarks and easily visualized
fascicles.
30/10/2023 48
49. Fascicular repair
Grouped fascicles are repaired in similar
manner to epineural repair
9-0 or 10-0 suture used to pick the internal
epineurium
Largest identifiable grp is repaired first.
Indication for single fascicular repair are
limited; Incomplete transection
30/10/2023 49
50. Conduit repair
Dissect nerve free of surrounding tissue for 5mm
Measure the diameter of the nerve, if<2.2mm a PGA
conduit is use
End of the nerve is brought into the conduit for
5mm
Minimum gap btw nerve ends is 5mm to allow the
internal environment exert its neurotropic effect
Conduit is sutured to the epineurium using 8/0
suture
The tube is infiltrated wt 1000u of heparin
in100mls of n/saline
Distal end of the nerve is now inserted into the tube
30/10/2023 50
52. Splint in safe position for post op
physiotherapy
Sensory re-education; patient learn to
interpret the pattern of abnormal stimulus in
a meaningful way.
30/10/2023 52
53. Medically unstable patient from other injuries
and/or illnesses
Presence of a grossly contaminated wound
bed
Active soft tissue infection in the region of
the nerve injury
Severely compromised nutrition
Patient unable and/or unwilling to comply
with required activity restrictions
Patient with unrealistic expectations
Presence of underlying skeletal instability
30/10/2023 53
54. This depends on the following
Type of lesion
• Neuropraxia always recover fully.
• Axonopmesis may or may not recover.
• Neuropmesis will not recover unless the nerve is
repair
Level of lesion
• The higher the lesion ,the worst the prognosis.
Type of nerve
• Pure motor or pure sensory nerve recover better.
Size of gap
• With size greater than two 2cm,end to end suturing is
not successful
30/10/2023 54
55. Age
• Children do better than adult,
Delay
• Most important factor, best result is achieved with
early nerve repairs.
Associated lesions
• damage to vessel, tendon may make recover of
useful function impossible.
Importance of use of suitable facilities can
not be over emphasized
30/10/2023 55
57. Nerve repair and grafting have benefited from the
development of microsurgical techniques and
advances in the neurosciences.
State-of-the-art nerve repair requires not only
precision techniques but also additional measures
to direct nerve regeneration to its original function.
30/10/2023 57
58. Although nerve grafting remains the
standard for reconstruction of the nerve
gap, synthetic conduits, allografts, and
nerve transfers now play a limited role in
the peripheral nerve surgeon's
armamentarium.
30/10/2023
58
59. Apley’s System of Orthopaedics and Fractures
Ninth Edition
GRABB AND SMITH'S PLASTIC SURGERY Seventh
Edition
https://www.orthobullets.com/hand/6066/periphe
ral-nerves-injury-and-repair
30/10/2023 59