Iatrogenic Nerve Injuries

Antoniadis, Gregor; Kretschmer, Thomas; Pedro, Maria Teresa; König, Ralph; Heinen, Christian; Richter, Hans-Peter

doi:10.3238/arztebl.2014.0273

Cited by 92 publications

(82 citation statements)

References 27 publications

(22 reference statements)

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“…Common procedures that may cause nerve injury are osteosynthesis, osteotomy, arthrodesis, lymph node biopsies from the posterior triangle of the neck, carpal tunnel release, Baker's cyst excision, varicose vein surgery and inguinal hernia repair [41].…”

Section: High-risk Surgical Proceduresmentioning

confidence: 99%

“…A study reported that the most common surgical interventions associated with peripheral nerve injury are as follows in decreasing order: 45% major procedures (orthopaedic procedures, abdominal surgery and trauma), 27% minor procedures (lymph node surgery and varicose vein surgery), 15% neurosurgical interventions (carpal tunnel operations and tenolysis), and 4% non-surgical interventions (arterial or venous puncture and plaster cast) [36,41].…”

Section: High-risk Surgical Proceduresmentioning

confidence: 99%

“…It is followed by the accessory nerve, radial nerve, common peroneal nerve (CPN), ulnar nerve and femoral nerve [41]. …”

Section: Peripheral Nerves and Clinical Presentations Of Injuriesmentioning

confidence: 99%

“…Direct intraoperative injury mechanisms include cutting, crushing, tying off, penetrating, twisting by screws, stretching by retractors, grabbing or squeezing by repositioned bone, coagulating with cautery or bipolar forceps, burning by cement or excision of the target pathology. It was reported that 94% of the iatrogenic peripheral nerve injury operations were caused by direct surgical damage [36,[41][42][43].Nerves cannot always be clearly visualized in the operative field. There are reports that they have been mistakenly recognized as a tendon or vessel [44][45][46][47].…”

mentioning

confidence: 99%

“…Additionally, excessive tractions of the nerves may be another injury mechanism (excessive traction of the shoulder causes brachial plexus injury). Anaesthesiologists should be aware of the body position and its association with nerve injury (e.g., lithotomy and femoral nerve injury, lateral decubitus position and peroneal nerve injury, taping the shoulders and brachial plexus injury) [41]. The American Society of Anaesthesiologists published a practice guideline for prevention of positioning-related peripheral nerve injury.…”

mentioning

confidence: 99%

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Peripheral Nerve Injury and Current Treatment Strategies

Tezcan¹

2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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Neuronal cells are the main fundamental anatomic unit of the system. Nerve injuries are generally divided into three categories as neuropraxia, axonotmesis and neurotmesis. Neurotmesis is the most severe form. Schwann cells are activated within 24 hours of the injury and the healing cascade continued with the cells, which are stimulated by Schwann cells. And neurotrophic factors like nerve growth factor (NGF) have a crucial role in regeneration and degeneration processes. Additionally, Schwann cells upregulate the expression of some proteins, such as fibronectin, which are crucial for axonal regeneration. All this information about nerve healing sheds light on treatment studies. Iatrogenic nerve injury has an important place in peripheral nerve injury. Causes may be direct surgical damage, wrong intraoperative patient positioning, anaesthesiarelated reasons or limb tourniquets. Typical symptoms are motor or sensory deficits such as paraesthesia, weakness, paralysis and pain. Many of the traumatic nerve injuries require surgical repair. Direct nerve repair and autologous nerve grafts are still goldstandard treatment options. Additionally, nerve conduits are very successful to provide an ideal peripheral support for neuronal recovery but are still insufficient. In recent years, research efforts have focused on the neurotrophic factors and cell-based therapies to perform better microenvironment for neuronal healing.Keywords: peripheral nerve, injury, iatrogenic, nerve grafts, conduit, cell-based therapy IntroductionAn injury to a nerve can result in a problem with the muscle innervation or in a loss of sensation. In some people, it can also cause pain. The type of nerve injury will determine the type of treatment that will be needed. Peripheral nerve injuries (PNIs) affect all age groups and have many causes like trauma and medical disorders. The majority of the peripheral nerve injuries © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.(PNI) occur in the upper extremity and are secondary to trauma [1]. Typical symptoms are motor or sensory deficits such as paraesthesia, weakness, paralysis and pain [2]. Many of the traumatic nerve injuries require surgical repair. The primary goal of the repair is to achieve the reinnervation of the target organs, but the therapeutic options which are used at present cannot achieve perfect sensory and motor recovery in all cases. In this chapter, the pathophysiology and mechanisms of nerve injuries, the traumatic nerve injuries, especially the iatrogenic forms, and therapeutic options for the peripheral nerve injuries will be discussed. Peripheral nerve anatomyPeripheral nervous system consists of neuronal cells, glial cells and stromal cells. Neuronal cells are the main fundamental anatomic unit of the system. Neurons conduct elec...

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Section: High-risk Surgical Proceduresmentioning

confidence: 99%

Section: High-risk Surgical Proceduresmentioning

confidence: 99%

“…It is followed by the accessory nerve, radial nerve, common peroneal nerve (CPN), ulnar nerve and femoral nerve [41]. …”

Section: Peripheral Nerves and Clinical Presentations Of Injuriesmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Peripheral Nerve Injury and Current Treatment Strategies

Tezcan¹

2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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Rapid Peripheral Nerve Imaging by Fluorescent Polymer Dots for Minimizing the Risk of Intraoperative Nerve Injury

Zhang,

Lu,

Tang

et al. 2023

Analysis & Sensing

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Iatrogenic nerve injury is an important cause of surgical complications. We focused on improving intraoperative visualization of nerves through highly fluorescent polymer dots (Pdots) and in vivo optical imaging instrumentation. The prepared Pdots have good biocompatibility, fluorescence stability, and simple preparation. Peripheral nerves can be imaged quickly with Pdots through a simple direct administration method and process, low non‐specific absorption in the surrounding tissues. Moreover, the Pdots does not invade nerve cells but binds stably in the neural membrane structure. This study verifies that fluorescent Pdots have excellent neuroimaging capabilities and can be used for intraoperative visualization of peripheral nerves.

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Label‐free in vivo imaging of peripheral nerve by multispectral photoacoustic tomography

Phillips

Wang

et al. 2015

Journal of Biophotonics

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Unintentional surgical damage to nerves is mainly due to poor visualization of nerve tissue relative to adjacent structures. Multispectral photoacoustic tomography can provide chemical information with specificity and ultrasonic spatial resolution with centimeter imaging depth, making it a potential tool for noninvasive neural imaging. To implement this label‐free imaging approach, a multispectral photoacoustic tomography platform was built. Imaging depth and spatial resolution were characterized. In vivo imaging of the femoral nerve that is 2 mm deep in a nude mouse was performed. Through multivariate curve resolution analysis, the femoral nerve was discriminated from the femoral artery and chemical maps of their spatial distributions were generated.

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Iatrogenic Nerve Injuries

Cited by 92 publications

References 27 publications

Peripheral Nerve Injury and Current Treatment Strategies

Peripheral Nerve Injury and Current Treatment Strategies

Rapid Peripheral Nerve Imaging by Fluorescent Polymer Dots for Minimizing the Risk of Intraoperative Nerve Injury

Label‐free in vivo imaging of peripheral nerve by multispectral photoacoustic tomography

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