By Götz Penkert, Hisham Fansa
No different publication covers as broadly all points of peripheral nerve surgical procedure. This contains the pathology and pathophysiology of compression neuropathies, worrying nerve lesions and nerve tumours, and their therapy with a variety of suggestions. All physique areas are defined adquately. the second one a part of the publication bargains with palliative surgical procedure for reconstruction of misplaced functionality. This features a entire array of muscle and tendon transfers, useful muscle transplantation and intramuscular neurotisation.
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Additional resources for Peripheral Nerve Lesions: Nerve Surgery and Secondary Reconstructive Repair
A ﬂap of skin and subcutaneous tissue is then prepared, revealing the fascia of the muscles and the epicondyle. The muscle fascia is at ﬁrst incised parallel to the expected nerve, proximal to the elbow; the nerve should be identiﬁed by palpation with a ﬁngertip within the muscles, the gliding tissue surrounding the nerve is then incised longitudinally over a few centimeters so that the nerve is identiﬁed with certainty. The further dissection starts in a distal direction, opening the roof of the bony groove between the olecranon and the medial epicondyle.
1). First, however, nerve trunks and nerve roots, the subclavian artery with its branches, the scalene muscles, and particularly in the beginning the phrenic nerve must be dissected and even isolated over a long distance, and the surgeon must gently set aside each individual structure; in summary, a very delicate approach. We avoid looping nerves during decompressive surgery, in contrast to surgery after trauma. Looped nerves may be kinked by the assistant surgeon, as can be seen with the inferior trunk in ᭤ Fig.
15 d). By means of a manual retractor, the skin under the incision edges is lifted up so that the thenar branch and the vessel arch are safely preserved during extension of the decompression. Microsurgical stepwise neurolysis may be exclusively indicated in CTS cases related to substantial trauma, particularly if severe paresis or atrophy of the thenar muscle occurred early. This atrophy indicates intraneural compressing scar tissue, which would remain in place after a simple external release. Microsurgery is the only procedure allowed and indicated when motor deﬁcits provide the strongest indication to surgery.