Operating on Peripheral Nerves

Birch, Rolfe

doi:10.1007/978-1-84882-108-8_7

Cited by 6 publications

(7 citation statements)

References 89 publications

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“…Age range (5-52 years), sex (24) male and (18) female, side (22) left and (20) right, mechanism of CPN palsy were Osteochondroma (4), ganglion (2), compound fracture (9), stap wound (6), gun shoot(5), knee arthrolysis surgery (1), schwannoma (3), donkey bite (4), calcified hematoma (1), knee dislocation (5), high tibial osteotomy (2). Time from lesion to surgery range (one day -11 months).…”

Section: Resultsmentioning

confidence: 99%

“…The motor functional unit formed of (single motor neuron and all muscle fibers innervated by it that follow all or non-law, innervation of muscles an axons of cell body in anterior of spinal cord branches near its ends to enervate several muscle fiber, forming neuro muscular junction called motor end plate) and sensory unit (peripheral sensory receptors in the skin and deep receptors in muscles), in injury of CPN must be not concentrate on site of lesion only but overview, as effects of injury produce pathology in muscle fibers, intra fusal muscle spindles, Golgi tendon organ and sensory receptors. Denervation of anterior and lateral leg compartments leads to muscle atrophy so early surgical repair, electrical stimulation and early motion prevent muscle atrophy by maintaining metabolic capacity of muscle fibers [2].…”

Section: Introductionmentioning

confidence: 99%

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Primary Nerve Repair with or without Tibialis Posterior Transfer for Management of Common Peroneal Nerve Palsy

2020

ARC Journal of Orthopedics

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Objective: As a result of high risk of failure rate with cases of common peroneal nerve (CPN) palsy with nerve gap defect more than 6cms when managed by sural nerve graft alone so we preferred to proceed directly to tibialis posterior (T P) transfer and sural grafting in one step and evaluate results of common peroneal nerve lesions (CPN) displaying nonfunctional regenerative signs. When explored and Intraoperative decision making to manage the lesions either by primary microsurgical nerve repair or one step primary nerve repair and tibialis posterior transfer reconstructive surgery to provide the patient the best chances of sensory recovery and useful motor functional outcomes. Methods: Forty two patients with common peroneal nerve lesions were managed in Zagazig university hospital (2013-2017), every cases of CPN palsy before surgery, we mentioned the potential of TP transfer during the surgery in one step. 16 cases primary microsurgical nerve repair was done by external neurolysis or internal interfasicular neurolysis. 15 Cases explored, neuroma excision and nerve graft if gap nerve defect less than 6 m with good number of motor end plate evidenced by MUNE of anterior and lateral leg muscles. (11) Cases managed by autologous sural nerve graft and tibialis posterior transfer if gap nerve defect more than 6 m with few number of motor end plate evidenced by MUNE of anterior and lateral leg muscles and viable sensory receptor evidenced by SEVP. Results: The follow up range (20-60) months, patients were satisfied with motor recovery grade (4) and (5) of BMRC, so in (16) cases neurolysis their results were excellent and satisfied in (15/16) (92.5 %). (15) Cases gap defect less than 6 cms were managed with primary nerve repair with sural nerve graft length (3-9 cms) their results were good and satisfied in (12/15) (80%) (11) cases of nerve gap defect more than 6 cm were managed by one step T P tendon transfer and primary nerve repair with sural nerve graft length (9.5-12 cms) their results were excellent and satisfied in (10/11) (90.9). In our study (42) cases with CPN lesions were managed by primary nerve repair or primary nerve repair and secondary TP tendon transfer in one step their motor results were excellent and satisfied in(37/42 , 88.1%), regarding sensory recovery of CPN palsy after our procedures (20) cases described complete sensory recovery (47.6%) and considered excellent results, (17) cases improved sensory deficit (40.4%) and regarded as good results, (5) cases with unchanged sensory deficit (11.9 %) and considered bad result, good and excellent results were considered by the patients as satisfied results. So in our study (37) cases reported satisfied sensory recovery after our procedures (37/42-88.1%). Neuropathic pain was recorded in (16) cases of CPN palsy, after our surgical procedures (6) cases showed complete regression, (7) cases improved with reduction of neuropathic pain, (3) cases recorded as unchanged neuropathic pain and referred to pain control clinic to manage them (13/16 , 81.2 %). Sign...

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Primary Nerve Repair with or without Tibialis Posterior Transfer for Management of Common Peroneal Nerve Palsy

2020

ARC Journal of Orthopedics

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“…Studies show discriminatory ability diminishes with age [33]; however, the current study shows a nonsignificant relationship between patient age and discriminatory deficit. Patient concentration has also been shown to influence results [34]. Another study showed that test repetition could improve discriminatory ability [35].…”

Section: Discussionmentioning

confidence: 99%

Sarcoma Excision and Pattern of Complicating Sensory Neuropathy

et al. 2014

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A potential complication of sarcoma excision surgery is a sensory neurological dysfunction around the surgical scar. This study utilised both objective and subjective sensation assessment modalities, to evaluate 22 patients after sarcoma surgery, for a sensory deficit. 93% had an objective sensory deficit. Light touch is less likely to be damaged than pinprick sensation, and two-point discrimination is significantly reduced around the scar. Results also show that an increased scar size leads to an increased light touch and pinprick deficit and that two-point discriminatory ability around the scar improves as time after surgery elapses. 91% had a subjective deficit, most likely tingling or pain, and numbness was most probable with lower limb sarcomas. Results also demonstrated that there were no significant relationships between any specific subjective and objective deficits. In conclusion, sensory disturbance after sarcoma surgery is common and debilitating. Efforts to minimize scar length are paramount in the prevention of sensory deficit. Sensation may also recover to an extent; thus, sensory reeducation techniques must become an integral aspect of management plans. Finally to obtain a comprehensive assessment of sensory function, both objective and subjective assessment techniques must be utilised.

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“…This structure suggests that schwannomas can be removed without damaging the underlying nerve fascicles (23, 24). However, post-operative complications of schwannomas have been reported at 1.5-80.0%, with neurological deficits as one of the major complications (14,(25)(26)(27)(28)(29).…”

mentioning

confidence: 99%