Posts Tagged ‘surgical repair’

Nerve Reconstruction

Contrary to the beliefs of many, that lower extremity nerve lesion repair has a relatively poor prognosis, Dr. Terzis has a large experience with the microsurgical repair of these lesions. Recent analysis of our patient population has yielded that in early lesions, good to excellent results can be obtained using a lot of the techniques she has introduced for the microsurgical care of these injuries, including use of vascularized nerve grafts, and use of vascularized fascia flaps to enhance the blood supply and facilitate regeneration through these long nerve grafts.

In regards to peroneal nerve lesions, in the late seventies, the prognosis for recovery of function following injury to this nerve was guarded. Over the past twenty years, Dr. Terzis has accumulated one of the largest series of common peroneal nerve lesions in North America by introducing new strategies of repair that are based on an understanding of the anatomical, neurophysiological, and vascular characteristics surrounding this particular lower extremity nerve.

The strategies of microsurgical reconstruction have been designed to combat appreciable nerve gaps, and compromised blood supply by provision of vascularized tissue that guarantees successful nerve regrowth. Dr. Terzis’ work shows that the surgical repair of lower extremity lesions is worthwhile, with the majority of results for early lesions ranging from good to excellent.

Nerve Injuries

Injuries to the peripheral nerves of the upper and lower limbs can be devastating. They can lead from temporary dysfunction to permanent paralysis of the affected extremity. Occasionally these type of injuries are associated with severe pain. Surgical repair of the injured nerve may not only reverse the paralysis but also may alleviate some of the pain.

Peripheral nerve injuries can be caused by the following mechanisms which can lead to either partial or complete transection of the involved nerve:
Stab wounds, gunshot wounds, or motor vehicle accidents these are usually complex injuries involving sometimes the bones, the nerves, the muscles and vessels.
Work related injuries. (i.e. amputations or avulsions of the arm) removal of nerve tumors with residual nerve paralysis.
Iatrogenic causes such as, inadvertent nerve injury during any type of surgery, sciatic nerve injection injuries or traction injury of the nerves of the lower extremity during sports or stabilization of fractures.

The surgical correction of these injuries usually involves exploration of the site, identification of the proximal and distal nerve ends, diagnosis of the lesion, establishing a strategy for reconstruction, going over it in detail with the patient and finally reconstruction. The surgery may be staged. If there is simultaneous vessel injury then a vascular surgeon is consulted in order to restore adequate circulation to the affected limb, so its survival is not threatened. Correction of bone fractures is essential before any attempt to correct the nerve injury is made. Therefore peripheral nerve injuries can range from simple injury limited to just the nerve, where the role of the microsurgeon is of prime importance, to complex injuries of the whole limb. In the latter cases different surgical specialties may work together to assure the salvage of the limb.