epineurium suture

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: peripheral nerve injury of 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. Exposure and dissociation: After the air tourniquet is inflated, the damaged nerve is revealed according to the peripheral nerve exposure pathway. Generally, starting from the normal tissue at both ends, the nerve trunk is gradually separated to the broken end until the two ends are completely free. The length of the nerve break is free, and the nerve energy at both ends is suitable. 2. Resection of the neuroma: Under a 6× operating microscope, the neuroma is pulled, and the neuroma is removed from the normal nerve with a sharp blade (for the fresh fracture, the contusion of the broken end is removed) until the nipple is densely covered. . The damaged part of the nerve and the scar tissue must be completely removed so as not to interfere with the regeneration of the nerve. The identification method for scars in the broken end is as follows: (1) There is no induration in the broken end of the finger, and if there is induration, there may still be residual scar tissue. (2) The broken end was observed with a 20×~25× operating microscope. The normal nerve bundle section is pale yellow, slightly protruding from the tunica, the boundary of the tunica is clear, and the tissue between the bundles is loose. 3. Excision of the scar tissue around the nerve ending, so that the sutured nerve is located in a well-organized tissue bed. 4. Stop bleeding: relax the air tourniquet and stop the bleeding completely. For nerve-end bleeding, first use a saline cotton ball to stop bleeding, if still stop bleeding, you can use the 9-0 line ligation under the operating microscope, or use a bipolar coagulator to stop bleeding. 5. Pair of nerve bundles: Try to align the two ends, if there is no retraction, it means that the two ends can be closed under tension. Under the observation of the operating microscope, the nutrient vessels and the mesenteric membranes of the two ends were first combined. According to the size and position of the nerve bundle on the section, one by one. 6. The outer membrane suture: at the two points of 0° and 180° corresponding to the two broken ends, one needle of the outer membrane was sutured with 7-09-0 without damage, and the knot was left for traction after knotting. Then, as with the endoscopic suture of small blood vessels, intermittently and equally stitched between the two fixed point lines. After the anterior lateral membrane was sutured, the nerve stump was inverted by 180°, and the posterior outer membrane was sutured in the same manner. Stitching must be performed under a surgical microscope. The tightness of the knotting is just as close to the two nerve bundles. The overtightening can cause the nerve bundle to curl. During the suture process, if the nerve bundle is exposed, it can be gently pushed in with the forceps to continue the alignment. Postoperative diet The diet after surgery should be reasonably matched, and reasonable dietary intake is the key to promoting rapid recovery after surgery. Modern clinical studies have confirmed that long-term consumption of foods containing vitamins is also important for reducing wound infections and promoting wound healing after surgery.