Post on 31-May-2015
Peripheral Nerve Injuries:Repair and Reconstruction
Dr hawre
• ANATOMY OF THE PERIPHERAEL NRVES• PHYSIOLOGY OF THE PERIPHERAL NERVE
ANATOMY OF THE PERIPHERAEL NRVES
Gross Anatomy Neuronal and Neural Anatomy
Gross Anatomy
Neuronal and Neural Anatomy
Neuronal and Neural Anatomy
Topography
IntraneuralTopography
PHYSIOLOGY O F THEPERIPHERAL NERVE
Blood Supply and theBlood-Nerve Barrier
Physiology of the peripheral nerve
• Excursion
Excursion
• Mesoneurium• Bands of fontana• Epineurium
The cellular response to nerve injury
• The injured nerve must survive• The distal end must create an inviting
environment• The target end organ must be able to receive
the regenerating axon
The Neuronal Responseto Axotomy
Cell support Apoptotic cell death
Macrophage
Glial cell
Target tissue
Neurotrophic factor
Apoptotic cell death
• Sensory neurons• Developing neurons• More proximal lesions
The Neuronal Responseto Axotomy
Formation and progression of the regenerating unit
Proximal unit
Distal environment
Mechanisms of neuronal regeneration
THE CLINICAL EVALUAETION OF NERVE INJURIES: SEDDON AND
SUNDERLAN CLASSIFICATION AND THE MACKINNON MODIFICATION
Six degree injury:neuroma-in-conontinuity
Clinical evaluation
History and examination Electrodiagnostic test
Electrodiagnostic test
Intraoperative NAP
Hour-glass appearance
cable nervegrafts.
rosebudt"e chniquein,
Epineural Versus Fascicular Repair
PRINCIPLES OF NERVE REPAIR
• l. Quantitative assessment• 2. Microsurgical technique• 3. Tension-free repair• 4. Primary repair is performed when feasible.• 5.nerve graft• 6. Postural maneuvers cannot substitute for a• tension-free repairwith grafting• 8. Repair is delayed for a minimum of 3 week• 9. Postoperative early movement• 10. Preoperativep hysicalt herapy
THE CLINICAL CLASSIFICATIONOF NERVE INJURIES: SEDDONAND SUNDERLANDCLASSIFICATIONS AND THEMACKINNON MODIFICATION