1. Peripheral Nerve Injuries:
Repair and Reconstruction
Dr hawre

2. • ANATOMY OF THE PERIPHERAEL NRVES
• PHYSIOLOGY OF THE PERIPHERAL NERVE

3. ANATOMY OF THE PERIPHERAEL NRVES
Gross Anatomy Neuronal and Neural Anatomy

4. Gross Anatomy

5. Neuronal and Neural Anatomy

6. Neuronal and Neural Anatomy

7. Topography

8. Intraneural
Topography

9. PHYSIOLOGY O F THE
PERIPHERAL NERVE
Blood Supply and the
Blood-Nerve Barrier

12. Physiology of the peripheral nerve
• Excursion

13. Excursion
• Mesoneurium
• Bands of fontana
• Epineurium

14. The cellular response to nerve injury
• The injured nerve must survive
• The distal end must create an inviting
environment
• The target end organ must be able to receive
the regenerating axon

15. The Neuronal Response
to Axotomy
Cell support Apoptotic cell death

16. Macrophage
Glial cell
Target tissue
Neurotrophic factor

17. Apoptotic cell death
• Sensory neurons
• Developing neurons
• More proximal lesions

18. The Neuronal Response
to Axotomy

19. Formation and progression of the
regenerating unit
Proximal unit
Distal environment

21. Mechanisms of neuronal regeneration

22. THE CLINICAL EVALUAETION OF NERVE
INJURIES: SEDDON AND SUNDERLAN
CLASSIFICATION AND THE
MACKINNON MODIFICATION

27. Six degree injury:
neuroma-in-conontinuity

29. Clinical evaluation
History and examination Electrodiagnostic test

30. Electrodiagnostic test

33. Intraoperative NAP

36. Hour-glass appearance

39. cable nerve
grafts.

42. rosebudt"e chniquein,

43. Epineural Versus Fascicular Repair

44. PRINCIPLES OF NERVE REPAIR
• l. Quantitative assessment
• 2. Microsurgical technique
• 3. Tension-free repair
• 4. Primary repair is performed when feasible.
• 5.nerve graft
• 6. Postural maneuvers cannot substitute for a
• tension-free repairwith grafting
• 8. Repair is delayed for a minimum of 3 week
• 9. Postoperative early movement
• 10. Preoperativep hysicalt herapy

45. THE CLINICAL CLASSIFICATION
OF NERVE INJURIES: SEDDON
AND SUNDERLAND
CLASSIFICATIONS AND THE
MACKINNON MODIFICATION