Complications in nerve surgery
At the end of the lecture the participant
will be able to:
• 1. List the possible complications and describe
their prevent...
Complications
• Immediate – as result of surgery
• Early – immediate post op period
• Late – secondary to nerve regenerati...
Immediate
• Non diagnosis – early/partial
• Pain – CRPS
• During surgery – iatrogenic injury of nerves and
vessels, nerve ...
Intermediate
• tender neuroma
• paralysis, and
• incomplete sensory
recovery.
• degree of cold intolerance
• Decreasing fu...
Late
• Dysesthesia and disuse
• Surgical failure - tension,
technique, poor vascular
bed
• Contractures
• Deformities – cl...
5219 procedures on 1819 patients
total complication rate was 2.91%
Perioperative complications in patients undergoing
peri...
Consenting
Complex regional pain syndrome
CRPS
• Type I - without a nerve lesion (commonest)
• type II – post nerve
• Increased sweat...
Pain Pract. 2009 Mar-
Apr;9(2):86-99
Current
understandings on
complex regional pain
syndrome.
de Mos
M, Sturkenboom
MC, H...
Budapest Diagnostic Criteria
CRPS
1. an inflammatory process
2. sympathetically mediated disorder
3. Central sensitization
4. autoimmune condition
5. l...
6 years after disease onset
• 30% completely recovered, and
• 54% of patients consider their disease as
stable
• 15% of pa...
Recommendations for the treatment
• Educated and self management
• specialized physio /occupational therapy
• Multidiscipl...
References
Rheumatology (Oxford). 2011 Oct;50(10):1739-50. Complex regional pain syndrome in adults.
Goebel A
Harden RN, B...
Complications in nerve surgery
Complications in nerve surgery
Complications in nerve surgery
Complications in nerve surgery
Complications in nerve surgery
Upcoming SlideShare
Loading in …5
×

Complications in nerve surgery

816 views

Published on

nerve surgery and complications, hand surgery, nerves, complications, nerve surgery,

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
816
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
14
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Complications in nerve surgery

  1. 1. Complications in nerve surgery
  2. 2. At the end of the lecture the participant will be able to: • 1. List the possible complications and describe their prevention and management • 2. Understand and manage complex regional pain syndrome
  3. 3. Complications • Immediate – as result of surgery • Early – immediate post op period • Late – secondary to nerve regeneration • Secondary effects
  4. 4. Immediate • Non diagnosis – early/partial • Pain – CRPS • During surgery – iatrogenic injury of nerves and vessels, nerve transfer/graft deficit of donor
  5. 5. Intermediate • tender neuroma • paralysis, and • incomplete sensory recovery. • degree of cold intolerance • Decreasing functional recovery • Non progressing Tinel
  6. 6. Late • Dysesthesia and disuse • Surgical failure - tension, technique, poor vascular bed • Contractures • Deformities – claw, Simian hand • Atrophic changes
  7. 7. 5219 procedures on 1819 patients total complication rate was 2.91% Perioperative complications in patients undergoing peripheral nerve surgery. Ducic I, Hill L, Maher P, Al-Attar A. Ann Plast Surg. 2011 Jan;66(1):69-72.
  8. 8. Consenting
  9. 9. Complex regional pain syndrome CRPS • Type I - without a nerve lesion (commonest) • type II – post nerve • Increased sweating, trophic changes, and vasoconstriction • related coldness of the affected limb • long been considered as results of autonomic (sympathetic) hyperactivity • 10% of patients report minor trauma
  10. 10. Pain Pract. 2009 Mar- Apr;9(2):86-99 Current understandings on complex regional pain syndrome. de Mos M, Sturkenboom MC, Huygen FJ.
  11. 11. Budapest Diagnostic Criteria
  12. 12. CRPS 1. an inflammatory process 2. sympathetically mediated disorder 3. Central sensitization 4. autoimmune condition 5. limb ischaemia /reperfusion injury 6. Cortical reorganization 7. nerve damage 8. Neurogenic inflammation
  13. 13. 6 years after disease onset • 30% completely recovered, and • 54% of patients consider their disease as stable • 15% of patients no improvement, • 30% unable to work Outcome of the complex regional pain syndrome. Clin J Pain 2009;25:590 -7de Mos M, et al
  14. 14. Recommendations for the treatment • Educated and self management • specialized physio /occupational therapy • Multidisciplinary pain management • drug or interventional treatments ( SCS etc) • Perioperative care • Long-term care SCS is the application of an electrical current to the spinal cord dorsal column through a catheter inserted into the epidural space
  15. 15. References Rheumatology (Oxford). 2011 Oct;50(10):1739-50. Complex regional pain syndrome in adults. Goebel A Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR.Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med 2007;8:32631 Kemler MA, Barendse GA, van Kleef M et al.Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med 2000;343:61824. Kingery WS. Role of neuropeptide, cytokine, and growth factor signaling in complex regional pain syndrome. Pain Med 2010;11:123950 Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity J Pain 2009;10:895926

×