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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