Novosti
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This journal is indexed in Scopus |
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Year 2022 Vol. 30 No 2
GENERAL & SPECIAL SURGERY
A.YU. NISHT, N.F. FOMIN
ANATOMICAL AND EXPERIMENTAL APPROACHES TO SUBSTANTIATION OF THE TECHNIQUES OF ACCELERATED SELECTIVE REINNERVATION OF THE THENAR MUSCLES IN PROXIMAL INJURIES OF PERIPHERAL NERVES
S.M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg,
Russian Federation
Objective. To provide a topographical and anatomical justification of techniques of accelerated selective reinnervation of the thenar muscles with high proximal trauma and extensive defects of the median nerve.
Methods. Structural features and topography of the muscular branches of peripheral nerves were studied on 37 upper limbs of cadavers. Modeling of the stages of reconstructive interventions with the connection of nerves according to the technique «end-to-side» was performed on 15 upper limbs in experiment.
Results. Individual differences in the structure of peripheral nerves mainly consist of the unequal quantity and size of bundles of nerve fibers, as well as the severity of intratrunk interfascicular connections and depend on the shape of the limb segments. The ulnar and the median nerves, a potential pair of «donor-recipient» nerves, are located reliably closer to each other on the relatively narrow and long limbs, compared to the wide and short ones. Based on the anatomical material the operative access was developed and tested to create optimal technical conditions for performing early selective reinnervation of the muscles of the first finger elevation in case of high proximal injuries and extensive defects of the median nerve. The essence of the proposed surgical intervention is to mobilize the recurrent motor branch of the median nerve and connect it «end-to-side» with the deep branch of the ulnar nerve.
Conclusion. Performing intra-trunk microsurgical operations on nerves with the formation of "end - to-side" perineural anastomoses allows creating morphological conditions for a directed regeneration of nerve fibers from the deep branch of the ulnar nerve to the tissues of the target zones of the recurrent motor branch of the median nerve.More extended nerve branches with a small number of interfascicular connections, characteristic of relatively narrow and long limbs, contribute to the creation of conditions for less traumatic mobilization and transposition of motor branches with aim to selectively reinnervate tissues with an «end-to-side» peripheral nerve suture.
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194044, Russian Federation,
St. Petersburg, Academician Lebedev, d. 6,
S.M. Kirov Military Medical Academy,
Department of Operative Surgery
(with Topographic Anatomy) Saint Petersburg, Russian Federation,
tel. +7 905 260-49-44,
e-mail: nachmed82@mail.ru,
Nisht Alexey Y.
Nisht Aleksey Y., PhD, Associate Professor, Doctoral Student of the Department of Operative Surgery (with Topographic Anatomy), S.M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0002-6696-1897
Fomin Nikolai F., MD, Professor, Head of the Department of Operative Surgery (with Topographic Anatomy), S.M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg, Russian Federation.
https://orcid.org/0000-0003-3961-1987
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