0%
TECHNIQUE VIDEO
0%
TECHNIQUE STEPS
 
0
0
TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Execute surgical walkthrough

  • describe the steps of the procedure verbally prior to the start of the case

2

Description of potential complications and steps to avoid them

F

Room Preparation

1

Surgical Instrumentation

  • loupe magnification

2

Room setup and Equipment

  • standard operating table
  • hand table

3

Patient Positioning

  • patient placed in the supine position with hand on hand table
  • place tourniquet high on the affected extremity
G

Incision

1

Make the incision over the injured nerve

2

Bluntly dissect to the injured nerve

3

Expose both ends of the injured nerve

H

Conduit Selection and Preparation

1

Mobilize the nerve

2

Measure the nerve diameter

3

Choose a conduit that is oversized by 1 mm

  • this is done to avoid constriction of the regenerating nerves

4

Rehydrate the conduit in saline for 5 minutes

I

Suture Placement

1

Place sutures

  • invaginate each end of the nerve into the tube for a distance of 5 to 8 mm using a mattress suture followed by anchoring suture for stability
  • first pass the suture through the tube from the outside in and 5 mm from the tube edge
  • pass the suture then transversely across the epineurium 3 mm from the edge of the nerve stump and then back through the tube in an inside to outside direction
J

Nerve Placement

1

Place additional sutures

2

Gently ease the nerve into the tube as the knot is tightened

  • place a simple suture between the epineurium and the edge of the tube at a diametrically opposite point to anchor the tube and prevent rotation

3

Repeat the same steps for the distal stump

  • fill the tube with saline using a fine cannula
K

Wound Closure and Immobilization

1

Expose the posterior face of the nerve

  • Irrigation and hemostasis
  • copiously irrigate the wound

2

Superficial closure

  • use running subcuticular nonabsorbable monofilament suture

3

Dressing and immediate immobilization

  • immobilize the extremity
  • place the elbow in 90 degrees of flexion
  • avoid wrist flexion greater than 20 degrees
Postoperative Patient Care
 

Please rate topic.

Average 5.0 of 1 Ratings

Topic COMMENTS (0)
Private Note