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PERIPHERALNERVEINJURIES
Dr.IbrahimErkutlu
Anatomicalbasis
• Theneuron
Anatomicalbasis
Oligofascicular nerve
Polyfascicular nerve
Endoneurium
Perineurium
External epineurium
Internal epineurium
PlexusformaBon
• Stretch-related– Themostcommon(Erbpalsy)
• LaceraBons– Thesecondcommon(knifeblade)
• Compression– Thirdcommon(SaturdayNightpalsy-radialnervecompression)
• InjecBoninjury– iatrogenic
• Electricalinjury– neuralandsoMBssueinjury
• IrradiaBoninjury– Postradiotherapy
CausesandmechanismsofPeripheralnerveinjuries
• ProximalregeneraBon6-8mm/day• DistalregeneraBon1-2mm/day.• 3sitesofdelay
– Ini$al:• thedefinitesprouttoappear,2-3wks
– Intermediate:• axonstocrossthelesionsite,3-4wks.
– Terminal:• conversionofthereinnervatedendorgansfromanatomicaltofuncBonal,4-6wks
RateofnerveregeneraBon
Seddon Sunder-land Pathophysiologic Basis
Neuro-praxia I Local myelin damage. Axons preserved. No
degeneration.
Axono-tmesis
II Endoneural tube preserved. Axon degeneration.
III Loss of endoneural tube continuity. Perineurium intact. Axon degeneration.
IV Endoneural tube and perineurium disrupted. Epineurium intact. Axon degeneration.
Neuro-tmesis V Complete loss of neural continuity.
ClassificaBonofperipheralnerveinjuries
• Historyoftrauma• PhysicalexaminaBon• ElectrodiagnosBcevaluaBon:NCV&EMG• Relevantradiographicstudies• IntraoperaBveelectrophysiologicalmonitoring
Diagnosisofperipheralnerveinjuries
• Recoveryspontaneously
• OperaBondesicion– decidewhethertooperate– decidewhentooperate– wheretooperate– whichoperaBontodo(appropriateoperaBon)
• OperaBontype– end-to-endrepair– nervegraMsbeusedandfromwhere?
ThechallengeforthesurgeonismulBfold
• RestoreconBnuity• ProvidetheopBmalse^ngforregeneraBon• ProvidetherecoveryofitsfuncBon.
TheAimofSurgery