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A-0185 Do surgeons agree on what constitutes tension at nerve repair sites?
Joshua M. Abzug 1, Fraser J. Leversedge 2, John S. Taras 3, Peter Tang 4, Harry A. Hoyen 5, Peter J. Evans 5, Scott H. Kozin 6, Pennsylvania, USA
Friday, June 15, 2018 · 6:31 p.m. · 05m 07s
Joshua M. Abzug 1, Fraser J. Leversedge 2, John S. Taras 3, Peter Tang 4, Harry A. Hoyen 5, Peter J. Evans 5, Scott H. Kozin 6 1 University of Maryland School of Medicine, Baltimore, Maryland, USA; 2 Duke Health, Durham, North Carolina, USA; 3 Drexel University, Philadelphia, Pennsylvania, USA; 4 Allegheny Orthopedic Associates, Pittsburgh, Pennsylvania, USA; 5 Case Western Reserve University, Cleveland, Ohio, USA; 6 Shriner's Hospital for Children, Philadelphia, Pennsylvania, USA
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00:00:02
okay well thanks for staying in the late evening uh i come in hell from the united states and the the study
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is uh uh it must disclose 'cause a partially funded by x. aegean a nerve company
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um and we tried to investigate a recurring tension that never parasites
00:00:20
so we know that tension never parasites leads to pour clinical
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outcomes to do imperative ask already impaired nerve regeneration
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cover we i don't know what the word tension means uh there's no true definition in clinical medicine currently
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so the purpose of the study was to assess whether or not certain which any
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performing or repair surgeries agree on how much tension is present one apparently nerve
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we had fifteen surgeons are commonly performed performed their surgery because bigness kind of or study
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we dissect out the common digital nerve to second third and fourth web spaces and then transported transacted them
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in randomised fashion one of these nerves had two millimetres uh additionally cut
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off representing trimming of the nerves of one millimetre from each side
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one of the nerves had five millimetres transacted representing tuna have no
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measures of a trimming on each side of the laceration
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we try to create a realistic scenario of cheering and their friends from acute injury
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the surgeons were then asked to assess the nerve gaps and
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tension beta visualisation alone as well devising tactile perception by
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we approximate interventions that are kissing each other a five point i could scale which utilise for each response
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so the first question with regard to visualisation alone was to rate the gap size and you'll notice from the left
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side to the right side one from the certain is when you there's a large cap too small gap
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and you can see here in the red the final years of nerve transacted uh
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the vast majority of surgeons philip was a large or moderate large cap
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however there was no real consensus one zero into mulder or sections occurred and you can see a thirty nine
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percent or responses were small to moderate or moderate and thirty nine percent of a more moderate larger large
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sort of with then asked to rate like that of a cheating attention free direct repair and again you'll know
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when fido menus of nervous transacted searches for that there was a low likelihood for this to be possible
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then they're asked to rate the level of tension present when they collected the nerve ends to each other since they're trying to kiss
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and again you'll notice wide variation amongst zero in two millimetres ah groups but i'm very high
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tension was present in the majority of a of a nurse at five millimetres transacted
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so no significant differences are present among the fifteen surgeons when
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we looked at the zero into millimetres transacted nerves
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and then for the nerd being repaired with the amount of tension be considered
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and you can see unacceptable was listed for five nobody's of nerve transaction
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so what can we learn well how much tension is present in or repair is not agreed upon by surgeons window nerve
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or to memories of nervous transacted however if we trained under five millimetres that being to have numbers on each side
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the vast majority surgeons feel that attention required to represent ignorance is very high moderate high
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and therefore we should consider us in conduits of neural grafting in these cases
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tension unfortunate continues to be a term that has no clear definition in clinical medicine
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even though the adverse affects attention endeavour per well characterised steps to uh to address or avoid
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tension should be considered whenever there's a risk of tension being present repair thank you
00:03:38
thank you it's a difficult to to any persons from the ones
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uh_huh
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we have the the question but the comment s. of working is really easy and oh oh
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what's the clinical break this was that if you take it it's
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you all mines euros to show for example to primary
00:04:01
call the medium of and one zero one zero zero one nine
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zero to choose enough and of tension is acceptable you've
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this is huge material is not of a purple bridge to keep the most times then
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it's too much tension and we have to graft is maybe a kind of standardisation
00:04:21
yeah so we've uh i heard that uh discuss uh throughout my training as
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well as in my cactus and various meetings that topic comes up
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as to shouldn't eight or nine o. suture hold the nerve the problem is is different
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turns out copies of the nerve based off of your dissection which interviewer trying to repair
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exact location of the nerve so i don't think that's a very reliable method at least it warrants further investigation for us
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to use that in clinical medicine currently the breakup lexus for example is not the same as the digital nerve
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other questions
00:04:59
i know that you're i think you're right
Conference Program
A-0358 New Open and Arthroscopic-Assisted Approaches of the Axillary Nerve
Andres A. Maldonado, Bassem T. Elhassan, Allen T. Bishop, Alex Y. Shin, Robert J. Spinner, 1 Department of Plastic, Hand and Reconstructive Surgery, BG Unfallklinik Frankfurt, Germany; 2 Department of Neurosurgery, Mayo Clinic, Rochester (MN), USA
June 15, 2018 · 6:17 p.m.
A-0596 Clinical and neurophysiological results two years after transfer of the interosseous anterior nerve (AIN) to the deep motor branch of the Ulnar nerve (DBUN)
Rasmus Thorkildsen 1, Frode Thu 1, Lars-Eldar Myrseth 1, Ellen Jørum 2, Inge Petter Kleggetveit 2, Lise Maurstad 3, Bjørg Bolstad 3, Magne Røkkum 1,4, Oslo, Norway
June 15, 2018 · 6:24 p.m.
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