Perineural Suture

Peripheral nerve injury within 1.8 to 12 hours, the pollution is light, and the possibility of wound infection is estimated to be small after debridement. Femoral suture or capsular suture can be performed. 2. Old or partial peripheral nerve rupture injury, after removal of the injured part and neuroma, 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. After the peripheral nerve injury or lesion resection, the nerve defect is >2.0cm, or when the limb is in the neutral position or the slightly flexed joint and the broken end are free, the two broken ends are still unable to match, and it is suitable for inter-beam nerve bundle transplantation. Treatment of diseases: peripheral nerve injury of neuroma Indication Peripheral nerve injury within 1.8 to 12 hours, the pollution is light, and the possibility of wound infection is estimated to be small after debridement. Femoral suture or capsular suture can be performed. 2. Old or partial peripheral nerve rupture injury, after removal of the injured part and neuroma, 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. After the peripheral nerve injury or lesion resection, the nerve defect is >2.0cm, or when the limb is in the neutral position or the slightly flexed joint and the broken end are free, the two broken ends are still unable to match, and it is suitable for inter-beam nerve bundle transplantation. Preoperative preparation Surgical design of the inter-beam nerve bundle transplantation, preoperative preparation of the skin of the donor area. The cutaneous nerve that can be used for transplantation has the sural nerve (a length of 25 to 40 cm for transplantation), a superficial branch of the radial nerve (for 20 to 25 cm), the medial cutaneous nerve of the upper arm, and the medial cutaneous nerve of the forearm (available for 20 to 28 cm). . The saphenous nerve, the lateral femoral cutaneous nerve, the posterior cutaneous nerve, and the intercostal nerve. The most commonly used graft nerve is the sural nerve, which is easy to expose, has few branches, and the numb area left after cutting is small, and is not in the weight-bearing area, followed by the superficial peroneal nerve. Surgical procedure 1. Exposure and dissociation: After the air tourniquet is inflated, the damaged nerve is revealed according to the peripheral nerve exposure pathway. Generally, starting from the normal tissue at both ends, the nerve trunk is gradually separated to the broken end until the two ends are completely free. The length of the nerve break is free, and the nerve energy at both ends is suitable. 2. Resection of neuroma: The method of excising neuroma is the same as that of the epicardial suture. After the neuroma was removed, the outer membrane of the two ends was resected 5 to 10 mm to expose the nerve bundle. Another method is to cut the normal adventitia close to the neuroma longitudinally and cut it about 5-10 mm, and then divide the normal nerve bundle into 4-6 bundles or bundles, and then follow the nerve bundle or bundle. The ends are separated until they are close to the scar tissue or neuroma, exposing the section of the normal nerve bundle and placing the sections on different planes. 3. Convergence of nerve bundles: In theory, the motor nerve bundles and sensory nerve bundles of the two broken ends should be correctly identified, and the corresponding sutures should be effective. Although there are many methods for distinguishing between motor nerve bundles and sensory nerve bundles, there are few simple and practical methods. The clinical methods used are: (1) Referring to the nerve bundle distribution map of different nerve sections of Sunderland, the motion bundles and the sensory bundles of the two fault ends are respectively combined. (2) Stimulate the distal nerve bundles or bundles with physiological electrical power. Anyone who causes contraction of the distal muscle is a motor nerve bundle. If there is no response, it is a sensory nerve bundle. Also stimulate the proximal nerve bundles or bundles, where the pain of the patient is the sensory nerve bundle, and vice versa, the motion bundle. (3) Firstly, the nutrient vessels and the mesangial membrane of the two ends are combined, and then according to the size, shape and position of the nerve bundle or the bundle, respectively. After the inspection is completed, the sensory bundles and the motion bundles at both ends are respectively combined and ready for suturing. 4. Stop bleeding: Loosen the tourniquet, completely stop bleeding, pay special attention to the hemostasis of the nerve ending. 5. Stitching: After the nutrient vessels on the surface of the nerve are placed at 0° and 180° from the outer membrane of the 20mm from the broken end, each needle is sutured with 7/0 non-invasive needles, and the knot is tied and the degree of the nerve bundle is drawn. Just contacted for the degree. At this time, if there is a poor union of the nerve bundle ends, the trimming may be repeated. The purpose of suturing the 2 needles of the outer membrane is to reduce the tension of the nerve ends, and to prevent the torsion of the ends, so that the nerve bundles can be accurately aligned. Use 9-0 or 11-0 non-invasive needles to suture the thicker nerve bundles or bundles. The needles only pass through the membrane, not too deep to avoid penetrating the nerve fibers. When the bundle is sutured, only the connective tissue surrounding the nerve bundle is sutured. Each nerve bundle has 1 to 3 needles, and the bundle can be stitched with 1 to 2 needles. The suture should not be too dense, and the knot should not be too tight to prevent the nerve bundle from curling. Generally, the nerve bundle in the center of the broken end is sutured, and the nerve bundle close to the outer membrane is sutured. When most of the nerve bundles are sewed, some small nerve bundles can be aligned with the tip of the sputum. After a while, the tissue fluid can be coagulated without suturing. The outer membrane traction line was adjusted, the nerve end was inverted by 180°, and the nerve bundle on the posterior side was sutured. After checking the nerve bundle is satisfactory, the outer membrane traction line can be removed [Fig. 1 (6)]. If the nerve ends have tension, the traction line can also be retained. Postoperative diet The diet after surgery should be reasonably matched, and reasonable dietary intake is the key to promoting rapid recovery after surgery. Modern clinical studies have confirmed that long-term consumption of foods containing vitamins is also important for reducing wound infections and promoting wound healing after surgery.

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