supraclavicular nerve transposition

Nerve shifting refers to sacrificing a small part of the secondary nerve function to restore the more important function of the affected nerve muscles, that is, some minor uninjured nerves are directly anastomosed to the distal end of the injured nerve either directly or through a neural bridge. Treatment of diseases: peripheral nerve injury peripheral nerve lesions 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 1. The phrenic nerve is displaced to the anterior femoral plexus. The accessory nerve is displaced to the superior scapular nerve. The slit design is as shown on the right. 2. Cut the skin and reveal the scapula of the scapula. 3. Cut, sew, and pull the scapula of the shoulder. 4. Reveal the transverse carotid artery. 5. Cut and ligature the transverse artery of the neck. 6. Expose the phrenic nerve on the surface of the anterior scalene muscle. 7. Expose the superior scapular nerve. 8. Expose the accessory nerve. 9. The phrenic nerve is connected to the anterior femoral plexus on the brachial plexus; the accessory nerve is connected to the superior nerve of the scapula. 10. 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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