- 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:
