Acute repair of median nerve laceration surgical technique
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Learn the Acute repair of median nerve laceration surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Acute repair of median nerve laceration surgical procedure.
Primary repair of an acute peripheral nerve laceration is a common procedure, performed by orthopaedic surgeons, plastic surgeons and others. A good outcome depends upon thorough careful examination and diagnosis followed by an early exploration and repair using a microsurgical technique.
Following a sharp laceration to any peripheral nerve, there is complete transection of axons. Axons within the distal stump of the nerve undergo a process termed Wallerian degeneration. This involves axonal degradation and loss of neuromuscular conduction.
The current standard surgical treatment is an epineurial repair with microsurgical techniques, some of which are demonstrated in this section. The aim of nerve repair is to realign the proximal and distal stumps to allow axons to regenerate into the distal stump and provide reinnervation.
Often a primary repair cannot be performed without excessive tension, either due to necessary debridement of the nerve ends, a delayed repair in a fibrotic bed or local anatomical factors.
In these cases an interpositional nerve autograft can be used to bridge the gap. More recently other technologies such as nerve conduits, and processed nerve allograft may be used to bridge small gaps and detension the repair site. All of these techniques are described elsewhere on Orthoracle.
The following case illustrates the technique used in the direct repair of a partial median nerve division in the forearm.
Author: Tahseen Chaudhry, Consultant in hand and peripheral nerve surgery
Institution: University Hospital Birmingham, Birmingham, United Kingdom
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.