interfascicular nerve transplantation

Peripheral nerve injury within 1.8 to 12 hours, the pollution is light, and the possibility of wound infection is estimated to be small after debridement. Femoral suture or capsular suture can be performed. 2. Old or partial peripheral nerve rupture injury, after removal of the injured part and neuroma, nerve defect <2.0cm, or when the limb is in the neutral position or slightly flexed joint (<20°) and the broken end is free, the two ends It can be used without tension, and it is suitable for suture or capsular suture. 3. After the peripheral nerve injury or lesion resection, the nerve defect is >2.0cm, or when the limb is in the neutral position or the slightly flexed joint and the broken end are free, the two broken ends are still unable to match, and it is suitable for inter-beam nerve bundle transplantation. Treatment of diseases: radial nerve injury neuroma Indication Peripheral nerve injury within 1.8 to 12 hours, the pollution is light, and the possibility of wound infection is estimated to be small after debridement. Femoral suture or capsular suture can be performed. 2. Old or partial peripheral nerve rupture injury, after removal of the injured part and neuroma, nerve defect <2.0cm, or when the limb is in the neutral position or slightly flexed joint (<20°) and the broken end is free, the two ends It can be used without tension, and it is suitable for suture or capsular suture. 3. After the peripheral nerve injury or lesion resection, the nerve defect is >2.0cm, or when the limb is in the neutral position or the slightly flexed joint and the broken end are free, the two broken ends are still unable to match, and it is suitable for inter-beam nerve bundle transplantation. Preoperative preparation Surgical design of the inter-beam nerve bundle transplantation, preoperative preparation of the skin of the donor area. The cutaneous nerve that can be used for transplantation has the sural nerve (a length of 25 to 40 cm for transplantation), a superficial branch of the radial nerve (for 20 to 25 cm), the medial cutaneous nerve of the upper arm, and the medial cutaneous nerve of the forearm (available for 20 to 28 cm). . The saphenous nerve, the lateral femoral cutaneous nerve, the posterior cutaneous nerve, and the intercostal nerve. The most commonly used graft nerve is the sural nerve, which is easy to expose, has few branches, and the numb area left after cutting is small, and is not in the weight-bearing area, followed by the superficial peroneal nerve. Surgical procedure 1. Surgical procedure in the donor area (cutting the sural nerve): Make all the mouth on the posterior side of the lateral malleolus, first find the small saphenous vein, and the sural nerve is behind the small saphenous vein. After separating and cutting it, use the mosquito clamp to pull . Then extend the incision against the midpoint of the calf, cut the skin and subcutaneous tissue, and gradually separate the sural nerve from the proximal side, and the small branch can be cut off. In general, the sural nerve is in the lower leg, the lower third of the fascia enters the deep fascia, and often meets here with the external phrenic nerve. The sural nerve and the external phrenic nerve can be harvested according to the length of the recipient nerve defect. If the length is not enough, the fascia can be cut, and the sural nerve can be traced up between the gastrocnemius and the lateral head, up to the armpit. After the length of the affected nerve defect is determined, the sural nerve is cut as needed. Because the nerve is retracted after cutting, the length of the sural nerve should be 15% longer than the actual length of the defect. If the median nerve defect is 6cm and is to be divided into 4 groups, the actual defect length is 24cm, plus 15%, then the length of the transplanted nerve should be 27.6cm. After the incision is fully hemostasis, the skin is sutured. 2. Receiving surgical steps (1) Exposure and free nerve endings, resection of neuroma, hemostasis, separation and optic nerve bundle or bundle group, same with neurosurgical suture. (2) The nerve is measured under no tension. (3) Under the microscope, the connective tissue outside the tunica is cut off, and a free sural nerve is embedded between the two ends of the nerve bundle. The broken ends are collocated, and the needles are broken by 9-0~11-0, and the suture is accepted. The bundle of nerves and the outer membrane of the transplanted nerve and the tunica, the tightness of the knot, and the nerve bundle cross-section just right. Generally, if there is no tension, the ends are well matched, and each bundle can be stitched with 1 to 3 needles. After one end is stitched, the other end is stitched. If 4 to 5 bundles must be transplanted at the same time, they should be sutured from deep to shallow. (4) The nerve after suturing should be placed in a receiving bed with no scar and good blood supply. 3. It is necessary to completely stop the bleeding or oozing of the nerve section, so as to avoid the formation of hematoma at the two ends after the anastomosis, and the formation of scar after mechanization, which hinders nerve regeneration. 4. Because the peripheral nerves are mixed nerves, the nerve bundles at the two ends are quite different. Coupled with the effects of anesthesia and neurodegeneration, it is difficult to completely match the sensory bundles and the motion bundles at the two ends. When bioelectrical stimulation is difficult to determine, it can be based on the size, location and morphology of the nerve bundle at the end of the nerve, and with reference to the Sunderland nerve bundle distribution map. If the alignment of the nerve bundle is really difficult, do not force the sacral suture, or consider suture. 5. The epithelium or capsular suture must be performed under no tension. Because, under the tension, the fissure will be generated between the ends of the nerve bundle, and the fissure will be filled by the scar, which hinders the regeneration of the nerve. 6. It is a reliable method to prevent the nerve trunk from twisting by tying the nutrient vessels at the broken end and suturing the 2-needle traction line in the outer membrane. 7. The soft tissue scar around the nerve trunk should be completely removed, so that the nerve suture site has a good blood supply bed. The length of the defect and decided to divide into several bundles for transplantation.