- Discussion:
- indicated in cases where a minimal number of group fasicles can clearly be indentified;
- may be indicated in lacerations of the
median and
ulnar nerves in the distal forearm;
- Operative Technique:
-
expsure and debridement:
- see:
phalangeal incisions:
- zone of injury must be defined;
- damaged nerve ends are sharply debrided to clean edge of fasicles;
- the epineurium is longitudinally incised and elevated off the group fasicles;
-
rotational alignment:
- an attempt is made to align group fasicles and/or longitudinal extra-neural vessels;
- if nerve ends are retracted, the ends can be approximated by transfixing the epineurium at each
end with small straight needles, which are then driven into soft tissue;
-
suture material:
- 9-0 or 10-0 non absorbable suture;
- each fasicular group is repaired w/ 2 or 3 interrupted sutures;
-
management of tension at nerve site repair:
- Case Example:
- medial antebrachial cutaneous nerve graft for phalangeal neuroma;
- by James A. Nunley MD
- phalangeal neuroma;
-
medial antebrachial nerve graft harvest;
- nerve repair technique:
