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Surgical Techniques in Nerve Repair

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Peripheral Nerve Tissue Engineering and Regeneration

Part of the book series: Reference Series in Biomedical Engineering ((TIENRE))

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Abstract

This chapter focuses on surgical strategies in nerve repair. Surgical treatment should be adapted to the type and proximity of the peripheral nerve lesion and the time interval since trauma. The gold standard for bridging a segmental nerve defect gap is still autologous interfascicular nerve grafting according to Millesi. However, sources of autologous nerve grafts are limited and therefore the use of nerve allografts and nerve conduits is discussed. If there is a loss of the proximal nerve stump and/or the calculated time interval for successful reinnervation seems to be too long, nerve transfers and end-to-side coaptation are possible treatment approaches. The main goal of our treatment is to provide a maximum of possible nerve fibers for reinnervation. This concept implies that peripheral nerve fiber transfer as the single source for reinnervation is not adequate. If possible, the nerve lesion must be explored and the reconstruction of the lesion should be part of the treatment. Muscle-tendon transfer after nerve reconstruction is an essential part of surgical strategy. Neurolysis is a procedure to decompress nerve fascicles after external compression and neural fibrotic changes. If this procedure is performed in a methodical way and the decompression of fascicles is the main goal, it is a useful therapeutic tool for all nerve compression syndromes. The importance of the gliding tissues around the nerve and their reconstruction in this type of pathology is comprehensively discussed. Finally, some basic strategies are provided for different types of brachial plexus injury, including functional free muscle transfer.

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Authors and Affiliations

  1. Millesi Center for Peripheral Nerve Surgery and Reconstructive Surgery, Vienna, Austria

    R. Schmidhammer

  2. Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria

    R. Schmidhammer & T. Hausner

  3. Trauma Surgery, AUVA Trauma Center Lorenz Böhler, Vienna, Austria

    R. Rosenauer & T. Hausner

  4. Department for Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria

    T. Hausner

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Editors and Affiliations

  1. Pharmacology, UCL School of Pharmacy, University College London Pharmacology, UCL School of Pharmacy, London, UK

    James Phillips

  2. Experimentelle u Klinische Traumatologie, Ludwig Boltzmann Institut für, Wien, Wien, Austria

    David Hercher

  3. Trauma Surgery, AUVA Unfallkrankenhaus Lorenz Böhler, Wien, Wien, Austria

    Thomas Hausner

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Schmidhammer, R., Rosenauer, R., Hausner, T. (2021). Surgical Techniques in Nerve Repair. In: Phillips, J., Hercher, D., Hausner, T. (eds) Peripheral Nerve Tissue Engineering and Regeneration. Reference Series in Biomedical Engineering(). Springer, Cham. https://doi.org/10.1007/978-3-030-06217-0_13-1

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  • DOI: https://doi.org/10.1007/978-3-030-06217-0_13-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-06217-0

  • Online ISBN: 978-3-030-06217-0

  • eBook Packages: Springer Reference EngineeringReference Module Computer Science and Engineering

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