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

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (0)
Private Note