nerve suture

Nerve suture is used for the treatment of peripheral nerve injury. Peripheral nerve injuries are common in both normal and wartime situations. According to some of the war damage statistics of the Second World War, nerve damage in the extremities accounted for 10% of the total number of traumas. In firearm fractures, about 60% have nerve damage. Omer reported 22% of patients with upper limb injuries with peripheral nerve injury on the battlefield in Vietnam. Usually peripheral nerve injury accounts for about 1.5% to 4% of all trauma. Proper grasp of surgical indications and timing of surgery is the key to performing surgical treatment and achieving good results. The timing of repair after nerve injury is very important. In principle, the sooner the better, but time is not an absolute factor, and late repair can also achieve certain effects. Treatment of diseases: peripheral nerve injury Indication Nerve suture is suitable for complete or partial fracture of nerves caused by various reasons, and can overcome the defect to reach the end of the fracture. Surgical procedure Incision Centering on the nerve injury site, the skin is opened by the nerve-exposed incision. The incision should be of sufficient length to expose the nerve. 2. Reveal the nerve When the nerve is exposed, it should start from the normal tissue at both ends of the injury site and gradually dissipate to the damaged site. After the nerve is released from the normal part of the incision, the nerve trunk is gently pulled up with a rubber strip, and then gradually released to the damaged part, taking care to retain the normal nerve branch. Free from the proximal and distal parts of the nerve ending to the fracture site, completely disengage the two ends, and do not damage the nerve branches. 3. Resection of the segmental nerve Before the excision, we can estimate whether the end can be anastomosed. The proximal pseudo-neuromas were excised piece by piece with a non-invasive blade, and the normal nerve bundle was exposed to the cut surface. The distal scar tissue and Schwann cell tumor were removed segmentally to normal nerve tissue. Suture nerve The nerve defect is overcome by means of free nerve, flexion joint, gentle pulling nerve or nerve displacement. The nerve is sutured at the opposite end without tension. The suturing method can be roughly divided into three types: epithelial suture, nerve bundle suture, and epicardial suture. The anterior method only sutures the epicardium, and if it can be accurately anastomosed, it can achieve better results. The bundle suture method separates the nerve bundles at the two ends under the operating microscope, and sutures the corresponding nerve bundles. This method can increase the accuracy of the two ends of the nerve bundles, but how to accurately identify the two There is no fast and reliable method for the nature of the broken nerve bundle (distinguishing between motion and sensory fibers). Therefore, there is a possibility of misalignment of the tunica suture, and extensive inter-beam separation is easy to damage the inter-branch nerve branch, and the scar at the anastomosis is also extensive. The experimental results show that under good repair conditions, the effects of the two anastomosis methods are not significantly different. It is generally advisable to use an outer membrane suture. Because it is simple and easy to perform, no special equipment is required. According to long-term clinical practice, its effect is far superior to other methods. For the nerves of the distal segment, the sensory fibers have been naturally separated, or the bundles with rare bundles, large bundles of nerves, and easy identification of the corresponding bundles can be sutured with a bundle. For partial nerve damage, after the normal and damaged nerve bundles are separated, the injured nerve bundle should be repaired by suture. (1) Epicardial suture method: 7-0 or 8-0 nylon thread was used to suture only the outer membrane of the nerve, and the nerve was not sewed. First, a needle is fixed on both sides of the nerve ending, and then the front line is sutured, and then a fixed line is wound around the nerve, and the fixed line is pulled to reverse the nerve and suture the back. The stitching should be accurately aligned and not reversed. Accurate alignment can be achieved based on the location of the nerve surface vessel and the shape of the section nerve bundle. The distance between the two stitches is such that the ends are well matched. In order to observe whether there is any breakage of the nerve suture at the postoperative site, a thin soft stainless steel wire can be sewed on the nerve membrane 1cm apart on both sides of the broken end, knotted for marking, and the position of the two metal knots can be observed through the X-ray film. . (2) Neurobumin suture method: performed under a surgical microscope. First, the anterior and posterior end of the nerve were removed by circumscribing one to two cm of the epicardium. According to the thickness and distribution of the nerve bundle at the end of the nerve, several groups of corresponding nerve bundles were isolated, and the scar tissue of each nerve bundle was removed to the normal tissue. The sections of the nerve bundles may not be on the same plane. The corresponding nerve bundles were sutured with a 10-0 nylon thread, and only the nerve bundle membrane was sutured, and the nerves were not sewed. The number of sutures is such that the ends of the two nerve bundles are aligned, generally 2 to 3 needles per bundle. (3) nerve adventitia, sac suture method: under the microscope, longitudinally cut the proximal and distal nerve epithelium, revealing the nerve bundle. The nerve back is sutured first. A 9-0 or 10-0 non-invasive nylon thread was used to sew through the neuroepithelium at one end and a certain nerve bundle to the corresponding neurotransmitter and epithelium at the other end. In the central part of the nerve, the suture is sutured. (4) nerve partial rupture suture: performed under a microscope or magnifying glasses. The nerve injury part and the normal part are carefully identified, and the neuroepithelium is longitudinally cut along the longitudinal axis of the nerve, and the normal part of the nerve bundle is separated to protect the lesion segment at both ends of the fractured nerve, and the nerve bundle membrane suture method is used. Accurate stitching. The small nerves are difficult to grasp by the general suture method, and the nerve reverse suture method can be used, and the knot is tied to the outer nerve epithelium. 5. Suture incision After the nerves are anastomosed, they are placed in healthy tissue, hemostasis, flushing the wound, suturing the incision layer by layer, and retaining the rubber drainage strip if necessary.