NEURO SURGICAL procedeur 7 Peripheral nerve repair

Peripheral Nerve Repair

Objective

The repair of a severed peripheral nerve to achieve: 

•   Accurate apposition by elimination rotational malposition 

•   Excision of neuroma 

•   Accurate suturing of nerve sheath.

Position

Varies with nerve for repair.

Anesthesia

Local, spinal or general.

Procedure

1.  Skin incision for direct access to severed nerve site.

2.  Muscles split or retracted.

3.  Nerve mobilized to relieve tension.

4.  A large gap in nerve ends may require nerve graft.

5.  Fibrous neuroma excised.

6.  Nerve sheath sutured using non-absorbable suture.

7.  Wrap repaired nerve in silastic sheet cover.

8.  Wound closed.

Instruments

•   General set 

•   Fine dissecting forceps, toothed (Gillies), 2 

•   Fine dissecting forceps, non-toothed (McIndoe), 2 

•   Micro dissecting forceps 

•   Micro artery forceps 

•   Fine artery forceps, curved on flat (Mosquito), 6 

•   Fine artery forceps, sharp points Iris scissors, curved on flat, sharp points 

•   Razor blades breaker and holder 

•   Razor blades 

•   Plastic tubing or tape for nerve traction 

•   Retractor, self-retaining (Mayo) 

•   Plaster of Paris back slab, or similar splint 

•   Nerve sutures for both operation areas 1 or 0.75 (5/0 or 6/0) synthetic non-absorbable on a small curved round-bodied non-traumatic needle 

•   19 Micron metallized synthetic non-absorbable suture 

•   Ligatures and sutures for an arm operation 

•   2 and 2.5 (3/0 and 2/0) plain catgut or synthetic absorbable for ligatures 

•   3(0) Chromic catgut or synthetic absorbable on a medium half-circle cutting needle for skin sutures 

•   2.5 (2/0) synthetic non-absorbable or silk on a medium curved cutting needle for skin sutures 

•   Ligatures and sutures for a leg operation 

•   2.5 and 3 (2/0 and 0) Plain catgut or synthetic absorbable for ligatures 

•   4 or 5 (1 or 2) chromic catgut or synthetic absorbable on a medium or large half-circle cutting needle for muscle sutures.

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