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PERIPHERAL NERVE INJURIES
AND VIDEOS OF REPARATIVE SURGERY
MOST COMMON
PERIPHERAL NERVES INJURIES
The box below, for scientific and informational purposes, presents an image taken from a YouTube video by Professor Ebraheim of the University of Toledo, which summarizes in English the most common peripheral nerve injuries, the resulting muscle strength deficits, sensory alterations, and clinical signs.
The nerves most commonly affected by traumatic injuries and the resulting pathological changes are:
Long thoracic nerve injury - winged scapula.
Posterior interosseous nerve injury - the patient can extend the wrist, but no finger extension.
Radial nerve injury - often related to a humerus fracture, wrist drop.
Femoral nerve injury - inability to extend the leg (differential diagnosis: quadriceps tendon tear, patellar tendon injury, patella fracture).
Median nerve injury – weakness of the thenar muscles of the hand and numbness of the hand.
Anterior interosseous nerve injury - the patient cannot make the O.K. sign.
Ulnar nerve injury - claw hand, distal ulnar nerve injury, positive Froment's sign.
Axillary nerve injury - usually due to shoulder dislocation, is characterised by weakness of shoulder movement and numbness of the skin of the lateral shoulder.
Posterior tibial nerve injury - pain and numbness of the plantar foot and heel.
Common peroneal nerve injury - foot drop.
READ BEFORE PROCEEDING
WARNING TO VISITORS
The images shown in the surgical videos below may be disturbing to some viewers.
THOSE WHO DECIDE TO ACCESS SURGICAL VIDEOS IMPLICITLY CONSENT TO VIEWING THEM
ULNAR NERVE INJURY
SURGICAL TECHNIQUE:
END-TO-END NEURORRHAPHY
Traumatic injury of the ulnar nerve with almost complete nerve transection.
Nerve reconstruction performed by end-to-end neurorrhaphy (END TO END) and submuscular transposition according to the LEARMONTH surgical technique to avoid tension at the level of the sutured nerve stumps, which allows for the best clinical results.
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INJURY OF THE AXILLARY NERVE (OR CIRCUMFLEX NERVE)
SURGICAL TECHNIQUE: EXTRAPLEXAL NEUROTIZATION - BERTELLI PROCEDURE
Traumatic injury of the axillary nerve.
With this technique, described by BERTELLI, the surgical treatment of the axillary nerve injury is performed with a "NERVE TRANSFER" using a tricipital branch of the radial nerve as the "donor." The goal is the functional recovery of the deltoid muscle.
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PREGANGLIONIC LESION BRACHIAL PLEXUS
SURGICAL TECHNIQUE: EXTRAPLEXAL NEUROTIZATION - OBERLIN PROCEDURE
The NERVE TRANSFER technique described by OBERLIN mainly uses a motor fascicle of the ulnar nerve, which is transferred and sutured to the motor branch of the biceps muscle to restore forearm flexion. Using this technique, the expected result is the recovery of the biceps muscle and is generally satisfactory but depends on several factors: the nerve suture performed in a healthy area, the use of a single suture without the need for nerve grafts, the short distance for axonal regeneration to reach the muscle target, and the use of a well-vascularized nerve for the transfer. This is a procedure that does not cause morbidity at the donor site.
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SUPRACLAVICULAR BRACHIAL PLEXUS INJURY
SURGICAL TECHNIQUE: NEUROMA REMOVAL AND SURAL NERVE GRAFT
Traumatic injury of the brachial plexus at the level of the upper primary trunk with neuroma formation.
The brachial plexus is inspected with a double surgical approach, supra- and infraclavicular, to rule out a double level of injury.
For the reconstruction of the brachial plexus, after removing the large neuroma, the sural nerve is harvested, prepared, and grafted.
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HARVESTING OF THE SURAL NERVE
FOR NERVE GRAFTS
When nerve injuries require a nerve graft, another nerve is used to fill the loss of nerve tissue.
The nerve commonly used as a "donor" is the sural nerve, located on the lateral side of the leg and a purely sensory nerve, so its removal will not cause any loss of muscle strength in the leg or foot.
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