Kirurgija poškodb perifernega živčevja = Surgery of the peripheral nerve injuries
Bošnjak, Roman
Blunt or sharp injury to the peripheral nerve (PN) affects the whole population of axcuis or only a part of it. A peripheral nerve responds to injury in a predictable manner regardless of the ...etiology of the injury. The degree of injury is dependent on the duration and strength of mechanical force. Drug injection or electrical injuries to the PN are rare. Surgical repair is used to restore the continuity between proximal and distal axons, without which functional recovery will not occur. Lesions in continuity need surgical treatment when intrafascicular fibrosis prevents axonal regeneration into, distal endoneurial tubes. Direct repair consists of epineurally or perineurally placed sutures. If a gap occurs between the nerve stumps or stumps are created after excision of neuroma in continuity, an interpositionalgraft using harvested cutaneous nerve from the patient is the used to bridge the gap. Nerve transfer refers to the transposition of freshly cut normal nerve to the distal stumps of the injured nerve in root avulsions from the spinal cord. Only in clean, sharp lacerations of the nerve should it be repaired acutely. The goals of surgical repairs are to appose healthy nerveends with minimal tension on the suture line and to align the fascicles, allowing appropriate re-innervation of target organs. Entrapment of nerves occurs as the nerves normallv pass through narrow constraint areas (fibrosseous tunnel or fibrotendineus arcades). Sustained compression causes structural changes. Complete and permanent PN lesion can be caused by prolonged or severe compression. (Abstract truncated at 2000 characters).
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