Repair Injuries Peripheral Nerve

Introduction
a. Definition
Repair of peripheral nerve injury is a surgery that aims to improve peripheral nerve injury.
b. Scope
Peripheral nerve injury both open and closed frequently encountered a surgeon. Principle - general principles in dealing with peripheral nerve injury based upon a good understanding of basic biological-daasr nervous system and its response to trauma.
Traditional classification of peripheral nerve injury is klasifiaksi Seddon. Seddon describes the three kinds of injuries are: neuropraksia, axonotmesis and neuotmesis.
Neuropraxia
Is non-functioning of the nervous system without the occurrence of a temporary physical disruption of axons. Usually the nerve function will return to normal after 2-4 weeks.
Axonotmesis
Is the disruption of axons and myelin. Yes sekitarn soft connective tissue including intact endoneurium. Axon degeneration occurs distal and proximal location of the trauma. Distal degeneration known as Wallerian degeneration. Axon regeneration will memngalami with speed 1mm / day. Significantly the function will return to normal after 18 months.
Neurotmesis
Is the disruption of axons and endoneurial. Peripheral components such as collagen can epineurium intact or disruption occur. Axonal degeneration occurs in the distal and proximal segments.
c. Operation Indication

    * Complete nerve lesions caused by lacerations or penetrating injuries
    * Other nerve lesions are quite meaningful without clinical or electrophysiological improvement after 3-6 months of clinical observation
d. Contra indications of operation (no)
d. Diagnoses

    Acute inflammatory demyelinating * · Polyradiculoneuropathy
    * · Cervical Spondylosis: Diagnosis and Management
    * · Diabetic Neuropathy
    * · Femoral Mononeuropathy
    * · Guillain-Barre Syndrome in Childhood
    * · HIV-1 Associated Acute / Chronic inflammatory demyelinating polyneuropathy
    * · HIV-1 Associated Distal Painful sensorimotor polyneuropathy
    * · HIV-1 Associated Multiple Mononeuropathies
    * · HIV-1 Associated Neuromuscular Complications (Overview)
    * · Leptomeningeal carcinomatosis
    * · Metastatic disease to the Spine and Related Structures
    * · Peroneal Mononeuropathy
    * · Polyarteritis nodosa
    * · Radial Mononeuropathy
    * · Spinal Cord Hemorrhage
    * · Spinal Cord Infarction
    * · Syringomyelia
    * · Vasculitic Neuropathy
e. Examination Support
EMG (Elektromyografi)
Engineering Operations
Operating techniques that can be applied to peripheral nerve repair include internal and external neurolisis. External Neurolisis done by freeing the nerve from surrounding tissues are circumferential. Internal Neurolisis indicated for partial nerve lesions that require separate reparations between fasikulus fasikulus nerve functioning nerve is not functioning. This procedure has the potential to injure the axons to regenerate and be done with electrophysiological guidance. In general, the internal neurolisis dissection segment includes non fungional. Then fasikulus already made reparations didiseksi end to end with or without a nerve graft.
Reparations end to end is preferred that occurs when a small gap and both ends can be brought near without stress / tension meaningful. Tension will hinder the healing process. If a considerable distance, it can be done graft interposition. Generally the donor nerve is taken from the superficial sensory nerves such as autologous nerve suralis. Monofilament suture (7.0 to 10.0) in the epineurium is used to bring fasikulus. Nerve ends should be resected to healthy fasikulus to get a good orientation and optimize repair functions. Yet continuity fasikulus anatomically not guarantee the regeneration of axons. Two causes of the failure is not good preparation and a tension-laden stump. Secondly it will cause the occurrence of scar interneural sarabut that would interfere with nerve regeneration.
Complications of surgery
Anastomosis failure
Mortality (none)
Postoperative care
After the occurrence of peripheral nerve injury, it is essential that patients have to undergo physiotherapy to maintain ROM and to prevent immobilization to optimize healing of motor function in conjunction with the occurrence of muscle reinervasi.
Follow-up
EMG monitoring is helpful to detect early signs of muscle reinervasi few months before the contraction is clinically available.