- MeSH
- Fibrin Tissue Adhesive therapeutic use MeSH
- Rabbits MeSH
- Neural Conduction MeSH
- Peripheral Nerves physiology surgery MeSH
- Nerve Regeneration MeSH
- Suture Techniques MeSH
- Animals MeSH
- Check Tag
- Rabbits MeSH
- Animals MeSH
- Publication type
- Comparative Study MeSH
- MeSH
- Anastomosis, Surgical MeSH
- Decompression MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Recurrent Laryngeal Nerve surgery MeSH
- Thyroidectomy methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Ve sdělení autoři shrnují patofyziologii poranění nervů, pojednávaj í o diagnostice lézívratného nervu, o indikaci jeho revize, včetně chirurgických poznámek, a o léčebných metodáchobrn hlasivek. Popisují výsledky dekompresí a sutur vratného nervu poraněného při strumektomiiu 21 nemocných (30 vratných nervů) a stehu bloudivého nervu po řezném ztrátovém poranění nakrku u jednoho pacienta. Průměrná doba sledování činila 2,6 roku s rozmezím 10 měsíců až 5 let.Dekomprimovali 17 nervů, 1krát užili fibrinové lepidlo u částečně přerušeného rekurentu a 13nervů autoři sešili.Zkušenosti autorů vycházejí z 807 tyroidektomií, při kterých rutinně vizualizují vratný nerv. Dvědekomprese a dvě úspěšné peroperační sutury rekurentu pocházejí z vlastního souboru operovaných nemocných, ostatní revize vratného nervu byly doporučeny z jiných pracovišť. Výsledky autoři objektivizovali laryngostroboskopickým vyšetřením a 7krát provedli elektromyografii hrtanových svalů. EMG vyšetření korelovalo s klinickým nálezem. Výsledky dekompresíi sutur vratného nervu byly velmi dobré u časných revizí, tj. do sedmi dnů od vzniku léze postrumektomii.
The authors summarize the results of decompressions and sutures of the recurrent laryngeal nerve injured during strumectomy in 21 patients (30 recurrent nerves used to bridge the defect between stumps of the recurrent nerve without tension), 4 times they made an anastomosis of the distal stump of the recurrent nerve with the r. descendens of the n. hypoglossi, in one instance anastomosis of the recurrent nerve with the vagus (its distal cervical portion was resected on account of a neurinoma propagating into Hashimoto’s goitre) and in one instance they sutured the vagus using an autograft. The authors’ experience is based on 807 thyroidectomies, where they visualize as a matter of routine the recurrent nerve. Two decompressions and two successful peroperative sutures of the recurrent nerve were made in the authors patients, the other revisions were referred from other departments. Twelve times the paresis of the vocal cord was unilateral. Ten times a bilateral lesion was involved, which called for urgent tracheotomy in nine patients due to severe inspiration dyspnoea with stridor. Only one female patient with bilateral paresis of the vocal cords was able to avoid tracheotomy. Localization of the nervous lesion regardless of the type of injury: 15 times the area of Berry’s ligament. 7 times at the site of crossing of the recurrent with the lower thyroid artery, 4 times caudally from the crossing of the n. recurrens with the lower thyroid artery and 4 times the nerve was compressed by a tough modular goitre. The autors expressed the results objectively by laryn- gostroboscopic examination and 7 times they used electromyography of the laryngeal muscles. EMG examination correlated with the clinical finding. The results of decompression and sutures of the recurrent nerve were very satisfactory in early revisions, i.e. within 7 days after development of the lesion following strumectomy. After early decompression in 11 patients the mobility of the vocal cord and phonation was restored perfectly. In two instances only the adduction movement of the vocal cord was restored and the occlusion of the intramembraneous rimae and voice improved. Decompression of the nerve com- pressed by the goitre (clinically manifested by paresis of the vocal cord for several months) led three times to improved mobility of the vocal cord by cca one third and to improvement of the voice. In one instance this late decompression was not successful. The results of early sutures of the recurrent nerve were very good. Ten times there was partial adjustment of the adduction of the vocal cord, the phonation closure improved and there was significant improvement of the voice. In one instance the suture failed (it may have been however associated strain on the nerve at another site). In one instance the authors did not evaluate the effect of laterofixation of the ipsilateral vocal cord which the patient refused to eliminate. Bilateral suture of the nerve three months after development of the lesion was not a success. All nine patients with bilateral paresis of the vocal cords were decannulated. The mean period before decannulation was four months (range three weeks to one year). The prerequisite of decannulation was an adequate width of the intermembraneous rima. In two patients the lumen of the larynx was enlarged by chordectomxy and in one patient by chordedectomy with arytenoidectomy and insertion of a spacer from the thyroid cartilage into the anterior commissure. The authors recommend laryngoscopic examination on the day after strumectomy and early microsurgical revision of the injured recurrent nerve, preferably during operation or on the first day after surgery, but not laster than after seven days. Early suture of the recurrent nerve is considered the method of choice. If the surgeon visualized and saved the recurrent nerve during surgery, possible paresis of the vocal cord improves as a rule spontaneously and revision is therefore not necessary. Phoniatric reeducation and possible phonosurgical surgery of the larynx are part of patient care in injuries of the recurrent nerve.
Úvod: Poranění periferních nervů je často zjištěný klinický problém, který způsobuje funkční ztráty z dlouhodobého hlediska. I když byla u poranění periferních nervů zavedena do klinické praxe mikrochirurgická technika rekonstrukce, neuspokojivé výsledky týkající se funkčního zotavení v cílovém orgánu způsobují vyšší zájem o studie týkající se poranění nervů a biologii zotavení u poranění nervů. Materiál a metody: Ischiadický nerv u sedmdesáti dospělých potkanů Sprague Dewly byl přerušen a byla provedena primární anastomóza. Potkani byli rozděleni do tří skupin. V kontrolní skupině bylo ošetřeno 30 potkanů pomocí sutury, zbývajících 30 potkanů bylo ošetřeno fibrinovým lepidlem. Po 30 dnech byli potkani utraceni a ischiadické nervy byly histologicky vyšetřeny s morfometrickými a statistickými analýzami. Výsledky: Při mikrochirurgickém ošetření nervu se předpokládá, že umístění sutury způsobuje překážku rostoucím axonům a komprimuje krevní zásobení fasciklů a tím narušuje regeneraci konců přerušeného nervu po ošetření s možným vznikem neuromu. Na druhou stranu, fibrinové lepidlo je jednoduchá efektivní technika, která trvá časově kratší dobu než provedení sutury. Další výhodou této techniky bez sutury je, že brání poškození axonu jehlami a absence cizího tělesa minimalizuje zánětlivou reakci. Závěr: Doporučujeme používat fibrinové lepidlo, protože vykazuje menší zánětlivou reakci, menší množství jizevnaté tkáně, provedení je méně časově náročné a poskytuje lepší výsledky.
Introduction: Peripheral nerve injury is a frequently encountered clinical problem that leads to functional losses at the long-term. Although microsurgical repair has been introduced to clinical practice in peripheral nerve injuries, unsatisfactory outcomes regarding functional recovery in target organ cause an increasing interest on studies about nerve injury and biology of the recovery in nerve injuries1. Material and Methods: Sciatic nerves of seventy adult Sprague Dewly rats were transected and primary anastomosis was performed. Rats were then divided into three groups: Control group, while 30 rats were repaired with sutures, and the remaining 30 were repaired with fibrin glue. After 30 days the rats were sacrified and the sciatic nerves were investigated histologically with morphometrical and statistical analyses. Results: In microsurgical nerve repair, suture placement has been thought to cause hindrance to the sprouting axons and compress the blood supply to the fascicles, thereby impairing the regeneration of the transected nerve ends after repair, with possible neuroma formation. On the other hand, fibrin glue is a simple, effective technique, less time consuming than suturing. Another advantage of this suture-free technique is that it avoids injuring the axon with needles, and the lack of foreign bodies minimizes the inflammatory reaction. Conclusion: We recommend using fibrin glue as it demonstrates less inflammatory reaction, less scar tissue formation, it is less time consuming and provides better outcomes.
- MeSH
- Fibrin Tissue Adhesive * therapeutic use MeSH
- Rats MeSH
- Microsurgery MeSH
- Disease Models, Animal MeSH
- Sciatic Nerve surgery pathology injuries MeSH
- Peripheral Nerve Injuries * surgery MeSH
- Rats, Sprague-Dawley MeSH
- Nerve Regeneration MeSH
- Suture Techniques MeSH
- Sutures * MeSH
- Treatment Outcome MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Animals MeSH
- Publication type
- Comparative Study MeSH
Jednostranná paréza zvratného nervu vzniká nejčastěji iatrogenně. Její léčba je konzervativní i chirurgická. Autoři prezentují soubor 10 pacientů léčených v letech 2002–2007 s etiologicky rozmanitou anamnézou jednostranné parézy zvratného nervu a výsledky chirurgické léčby, která zahrnovala medializační tyreoplastiku a suturu přerušeného nervu. Jsou diskutovány indikace k chirurgické léčbě a její funkční výsledky v závislosti na zvoleném typu metody.
The main cause of unilateral recurrent laryngeal nerve palsy is iatrogenous injury. The treatment is conservative, surgical or combination of both. We present a retrospective cohort of 10 patients with miscellaneous etiologie factors causing a unilateral laryngeal nerve palsy. The surgical treatment methods included a thyroplasty and a nerve suture of injured nerve. Indication of surgical tratment as well as functional results of various methods are discussed.
- MeSH
- Financing, Organized MeSH
- Kymography methods utilization MeSH
- Humans MeSH
- Recurrent Laryngeal Nerve surgery physiopathology pathology MeSH
- Paresis etiology surgery MeSH
- Suture Techniques utilization MeSH
- Thyroid Gland surgery MeSH
- Video-Assisted Surgery methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
INTRODUCTION: Radial nerve palsy after humeral shaft fractures is often associated with formation of a neuroma in continuity. The current standard of treatment is neuroma resection and nerve grafting with contentious results. Anterior transposition of the radial nerve may reduce the length of its path, allowing reconstruction by primary suture. The aim of this study was to determine the maximum length of radial nerve defect that can be treated by the anterior transposition to allow primary suture to be performed. METHODS: We use 10 arms from five fresh cadavers. The radial nerve was dissected in the lateral inter-muscular septum and along the anterior aspect of the forearm. The radial nerve was transected at the level of the spiral groove and both stumps were than transposed anterior to the medial inter-muscular septum. The length of tension-free overlap that could be achieved was measured. RESULTS: The average length of the overlap at zero degrees of elbow flexion was 10.00 ± 1.84 mm. Theoretically, this will allow a defect of 20 ± 3.69 mm SD to be treated by primary suture. CONCLUSION: Our results suggest that anterior transposition can be used for radial nerve defects up to 2 cm; however, dissection of both stumps proved to be challenging.
- MeSH
- Bone Plates MeSH
- Humans MeSH
- Radial Nerve * surgery MeSH
- Neuroma * MeSH
- Feasibility Studies MeSH
- Sutures MeSH
- Fracture Fixation, Internal methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Adhesives therapeutic use MeSH
- Fibrin therapeutic use MeSH
- Rabbits MeSH
- Microsurgery MeSH
- Facial Nerve surgery MeSH
- Sciatic Nerve surgery MeSH
- Animals MeSH
- Check Tag
- Rabbits MeSH
- Animals MeSH
- Publication type
- Comparative Study MeSH
- Geographicals
- Turkey MeSH
Rekonstrukce lézí periferních nervů (PN) doznala svého současného vrcholu zavedením operačního mikroskopu s mikrochirurgickou technikou, instrumentáriem a šicími materiály. Svým dílem přispěly nové poznatky z patofyziologie degenerace a regenerace PN na subbuněčné úrovni s vypracováním pravidel pro časování postupů a pro podmínky sutury. Současná mikrotechnika se zdá být na hranicích svých možností limitovaných fyzikálními možnostmi materiálů, technologií i metodiky. Přes uvedený pokrok dojdeme rozborem výsledků k možnosti dalšího vylepšení a to hned v několika rovinách řešené problematiky. V této části předkládáme přehled a rozbor nezbytných teoretických poznatků degenerace a regenerace traumaticky poškozeného nervu na molekulární úrovni a zároveň zmiňujeme i nové technologie a materiály. Podrobným srovnáním efektu klasické metody (mikrosutury) a nové technologie (laser) nenacházíme však výraznější rozdíl a přednost metodiky je nutné hledat v její aplikaci, ne kvalitě a bude předmětem druhé části práce.
The reconstruction of traumatic lesions of peripheral nerves (PN) underwent the most significant improvement with the introduction of operating microscopes, microsurgical techniques and pertinent instruments, including microsutures. New information with respect to the pathophisiology of the degeneration and regeneration of peripheral nerves on a subcellular level also helped in the delineation of the rules and timig of optimal conditions for suturing. The present microtechnique seems to have reached its plateau with regard to capacity of available materials, technology and methodology. Despite this progress there is room for further improvement as addressed in this presentation. In this part of our work we would like to present a survey and analysis of the necessary theoretical knowledge of the basis of degeneration of a trumatized peripheral nerve at the level of molecular changes, as well as to indicate new technologies and materials. A detailed comparison of the classical method (microsuture) with the new technology (laser) has so far failed to demonstrate any significant difference. Therefore it appears necessary, when seeking advantages of the new methodology, to examine its application and not its quality, which will be the subject of the second part our work.
Acta oto-laryngologica, ISSN 0365-5237 suppl. 465, 1989
36 s. : il., tab. ; 26 cm
