RU2572752C1 - Method for nerve end suturing - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: central and peripheral nerve ends are vivified until observing normal fascicles; an epineural flap is formed; a subepineural suture of the central and peripheral nerve ends is formed, and the epineural flap is fixed. The central nerve end is vivified at the level of the greatest diameter of a regeneration neuroma around the circumference of the neuroma. An epineurium is mobilised; a circular epineural flap is formed and displaced in the proximal direction. Thereafter, the central nerve end is vivified until observing normal fascicles; the subepineural suture of the central and peripheral nerve ends is formed by aligning the ends circumferentially; the flap is turned out, and the circular epineural flap is fixed overlapping the epineurium of the peripheral nerve end.

EFFECT: method enables reducing postoperative complications in the form of regeneration neuroma formation and cicatrical process development that is ensured by the complete alignment of the nerve ends.

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Description

The invention relates to medicine, namely to neurosurgery, and can be used to restore the anatomical integrity of the interrupted nerve with different diameters of the ends of the nerve and with a diastasis between them more than 2 cm

A known method of suturing the ends of a nerve (Grigorovich K.A. Nerve surgery. - L .: Medicine, 1969. - S. 136-137). Refresh the central and peripheral ends of the nerve to a good picture of the bundles and their bleeding. The ends of the nerve bring together and overlap subepineural sutures. The disadvantages of the method: the impossibility of full comparison with different diameters of the central and peripheral ends of the nerve, the failure of the suture of the nerve with large diastasis between the ends of the nerve and the re-formation of the neuroma.

Closest to the claimed is a method of stitching the ends of the nerve (RF patent No. 2150895 from 06/20/2000), adopted as a prototype. Spend refreshment of the central and peripheral ends of the nerve with the abandonment of epineural flaps. The central end of the nerve is maximally pulled to the peripheral and fixed by the epineural flap to the underlying tissues in a tense state. Then the peripheral end of the nerve is brought down and fixed with an epineural flap to the flap of the central end. After that, matching sutures are applied to the bundles and bundle groups of transverse sections of both ends of the nerve lying without tension, opposite each other. Around the circumference of the transverse sections of the nerve, several subepineural sutures are applied.

The disadvantages of the prototype: the possibility of the formation of a neuroma with different diameters of the ends of the nerve, the development of the cicatricial process at the site of stitching of the ends of the nerve due to the fixation of the epineural flap to the underlying tissues.

The invention is aimed at creating a method of suturing the ends of the nerve, preventing the formation of regenerative neuroma and the development of the cicatricial process at the site of suturing the ends of the nerve.

The specified technical result in the implementation of the invention is achieved by the fact that in the known method of suturing the ends of the nerve, including refreshing the central and peripheral ends of the nerve to the normal picture of the bundles, the formation of the epineural flap, subepineural suture of the central and peripheral ends of the nerve and fixation of the epineural flap, the feature is that refreshment of the central end of the nerve is performed at the level of the largest diameter of the regenerative neuroma; s form a circular epineural flap and displace it proximally, then refresh central nerve end to normal beams operate podepinevralny seam central and peripheral nerve ends, comparing their circumferential evert flap and fixed circular epineural flap overlapping peripheral end to the epineurium of the nerve.

The invention is illustrated by drawings, where in FIG. 1, FIG. 2 and FIG. 3 shows: refreshment line 1 of the central end of the nerve, refreshment line 2 of the peripheral end of the nerve, epineural circular flap 3 of the central end of the nerve, subepineural suture 4 of the central and peripheral ends of the nerve, fixation point 5 of the circular epineural flap of the central end of the nerve to the epineuria of the peripheral end of the nerve.

The method is as follows. Refresh 2 peripheral nerve ends with the smallest diameter to the normal picture of the bundles, refresh 1 central end of the nerve according to the largest diameter of the neuroma. Around the circumference of the central end of the nerve, the epineurium is mobilized, forming a circular epineural flap 3, it is turned out and displaced proximal. Refresh the central end of the nerve to the normal picture of the bundles, perform the subepineural suture of the 4 central and peripheral ends of the nerve, comparing them around the circumference, under optical magnification and using microsurgical technique. After that, fix the circular epineural flap 3 with an overlap, close the subepineural suture and fix the 5 circular epineural flap to the epineuria of the peripheral end of the nerve with interrupted sutures.

The inventive method is developed and passed clinical trials at the Russian National Scientific Research Institute named after prof. A.L. Polenova in the treatment of 5 patients with peripheral nerve damage. All patients did not have the formation of regenerative neuroma and the development of a cicatricial process at the site of suturing of the ends of the nerve.

We give an example - an extract from the medical history.

Patient D., 36 years old. Medical history: 7 months ago, he was injured - a cut wound with glass of his right forearm in the upper third with damage to the ulnar nerve. Immediately after the injury, there is numbness in the region of 4-5 fingers of the right hand, weakness and hypotrophy of the muscles of the right hand (like a bird’s paw). When conducting electroneuromyography, a complete violation of conduction along the ulnar nerve was diagnosed at the level of the upper third of the right forearm.

According to the claimed method made the refreshment of the peripheral end of the nerve with the smallest diameter to the normal picture of the bundles, refreshment of the Central end of the nerve for the largest diameter of the neuroma. Epineuric mobilized around the circumference of the central end of the nerve, forming a circular epineural flap, twisted it and displaced proximally, refreshed the central end of the nerve to the normal picture of the bundles, performed the subepineural seam of the central and peripheral ends of the nerve, comparing them around the circumference, under optical magnification and using microsurgical technique . They turned out a circular epineural flap, overlapping the subepineural suture, and fixed it to the epineuria of the peripheral end of the nerve with interrupted sutures.

Within 12 months, the patient noted restoration of the function of the flexors of the hand and fingers to 4 points. After 18 months, muscle strength was restored to 5 points.

Using the proposed method provides a prevention of the formation of regenerative neuroma, the development of the cicatricial process at the site of suturing of the ends of the nerve due to the full comparison of the central and peripheral ends of the nerve, reducing the time of postoperative rehabilitation.

Claims (1)

A method of suturing the ends of the nerve, including refreshing the central and peripheral ends of the nerve to the normal picture of the bundles, forming an epineural flap, subepineural suture of the central and peripheral ends of the nerve and fixing the epineural flap, characterized in that the refreshing of the central end of the nerve is performed at the level of the largest diameter of the regenerative neuroma, according to the circles of the neuroma mobilize the epineurium, form a circular epineural flap and displace it proximal, then refresh the central to the nerve end to normal bundles, perform the subepineural suture of the central and peripheral ends of the nerve, matching them around the circumference, invert the flap and fix a circular epineural flap with an overlap to the epineuria of the peripheral end.

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