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Group Fasicular Nerve Repair

- 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: