Intercostal nerve transposition

Transpositionofnerve refers to the repair of the proximal nerve of the damaged nerve and the repair of the distal end of the damaged nerve by surgery. Get functional compensation. This type of surgery requires the use of motor nerves to repair motor nerve damage, and sensory nerves to repair sensory nerve damage, which maximizes nerve regeneration and rebuilds normal function control. In addition, it is also required to minimize the choice of donor nerves. Loss of function due to missing nerves in the donor area. Treatment of diseases: pathological nerve injury peripheral nerve injury Indication 1, 8 ~ 12 hours of peripheral nerve cutting injury, less pollution, after the debridement is estimated that the possibility of wound infection is small, feasible epithelial suture or capsular suture. 2, old or partial peripheral nerve rupture injury, after the removal of the injury part and neuroma, the nerve defect <2.0cm; or when the limb is in the neutral position or slightly flexed joint (<20°) and the broken end is free, the two ends It can be used without tension, and it is suitable for suture or capsular suture. 3, peripheral nerve injury or lesion resection, nerve defect > 2.0cm; or when the limb is in the neutral position or slightly flexed joint and the broken end free, the two ends are still unable to match, suitable for inter-beam nerve bundle transplantation. Contraindications Peripheral nerve microsurgery is characterized by a long duration of surgery and a large number of surgical areas. In addition to the damaged nerves, surgery must be performed, and sometimes an incision is required to cut the transplanted nerve. Therefore, it is necessary not only to anesthetize the nerve-damaged limb, but also to anesthetize the donor site. Due to the long operation time, continuous anesthesia is generally used. Preoperative preparation 1. Actively prevent and treat shock, timely and adequate blood transfusion, and supplement blood volume. 2. The isolated limbs are aseptically processed and stored in a refrigerator at 2 to 4 °C. 3. Prepare appropriate fracture fixation equipment according to the site of the limb. 4. Prepare surgical microscopes and microsurgical instruments. Surgical procedure The intercostal nerve is displaced to the thoracodorsal nerve. The intercostal nerve is displaced to the medial cutaneous nerve of the forearm. The brachial plexus and intercostal nerves show the incision design. Cut the anterior line incision of the chest wall, peel off the skin, cut the serratus muscle along the anterior serratus fiber, and reveal the intercostal space. The intercostal medial and lateral muscles were cut with the lateral cutaneous branch of the intercostal nerve. The intercostal nerve kinetic branch can be dissected by pulling the lateral cutaneous branch of the intercostal nerve. The third, fourth, and fifth intercostal nerve branches were dissected. The thoracodorsal nerve is revealed on the ventral side of the latissimus dorsi The intercostal nerves are connected to the thoracodorsal nerve. A drainage tube is built into the ankle wound. The brachial plexus is explored and the medial cutaneous nerve of the forearm is revealed in the subclavian incision. The intercostal nerve is connected to the medial cutaneous nerve of the forearm. Close the wound. complication (1) Insufficient blood volume: The main cause of insufficient blood volume in patients with broken limbs is blood loss. Reduced blood volume can not only cause shock, life-threatening, but also cause vasospasm and thrombosis of replanted limbs due to contraction of peripheral blood vessels, leading to failure of replantation. Therefore, the pulse, blood pressure, urine volume, jugular vein filling, skin temperature, color and capillary filling time of the broken finger (toe) should be closely observed after the operation. If the systolic blood pressure is above 14.22 kPa (100 mmHg) and the urine volume is >30 ml, the external jugular vein can be seen on the clavicle. The broken finger (toe) is rosy and warm, and the capillary filling time is less than 2 seconds, indicating that the blood volume is normal. If there is insufficient blood volume, the treatment is mainly infusion and blood transfusion, supplement blood volume, avoid applying pressure-boosting drugs, especially norepinephrine, so as not to cause strong contraction of blood vessels, resulting in anastomotic thrombosis. (2) Acute renal failure: a patient who has a long-term shock, or a long-term ischemic limb ischemia, has a tissue degeneration, or has a high plane of the broken limb and has a large number of muscle injuries. After revascularization of the limbs, special attention should be paid to the occurrence of acute renal failure (expressed as oliguria, urinary retention, hemoglobinuria, low urine specific gravity, elevated blood urea nitrogen, increased blood potassium, etc.). This complication should focus on prevention; such as timely correction of shock, strict control of the indications for replantation of the broken limb, thorough debridement, removal of all inactivated muscles, incision of fascia decompression, and appropriate postoperative infusion, static point rate Urine, accelerates the excretion of toxic substances to prevent the occurrence of acute renal failure. Once it occurs, it should be actively treated, such as limiting the amount of intake, controlling hyperkalemia, correcting acidosis and azotemia. If there is no improvement, if you continue to retain the broken limb and will endanger the patient's life, you should get rid of the replanted limb as soon as possible. (3) Prevention of infection: As mentioned above, the key to preventing infection of the broken limb is a thorough debridement. Prophylactic antibiotics should continue throughout the body after replantation.

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