Player is loading...
A-1303 Evolution of my algorithm for the surgical management of pain
Joaquim Casanas, USA
Wednesday, June 13, 2018 · 2:03 p.m. · 18m 50s
Embed
Embed code is not allowed
This talk is part of a Private webcast, embeding is not permited.Transcriptions
Note: this content has been automatically generated.
00:00:00
before imitation adjust to try tool to explain briefly in sixty minutes what does the management
00:00:05
of the of the pink cases where it's so difficult to understand what it's
00:00:09
uh the region of the neural but the pain because it that complex in them
00:00:13
and and symptoms of of the one that plays on every some widget so
00:00:18
and we must to understand so what is the best ways to to to to trade passions that way suffering
00:00:24
uh but if i don't have a disorders with our party p. so one of them
00:00:27
as the old one of the most principle that we have tool to complain is
00:00:32
to understand that always never kristen sect that wheezing to it to try to be reconnected
00:00:37
to the east of the storm is one of the of the principles hole
00:00:40
the neural most format on the proximal storm a hole that you always format on the distance time
00:00:45
and so this is one of the principles and we must keep in mind in order to understand what does that the phase of pathology
00:00:50
and what is it that the reason has had more whole the doctor about tipping happens
00:00:55
it's very important to try to avoid too great any case that we can the labs they there
00:01:02
aerobatic plane that's mean that when you have any injury have any tomorrow we must to reset we
00:01:07
have any problem that we must to trade we must to to keep in mind in order
00:01:12
to try to to to to keep the continuity on the nerve and and try to manage them
00:01:17
have properly in order to avoid too great few roses and to create problems so um
00:01:23
i easy way to all to tool to manage the the the neural by
00:01:28
tipping his orders on their the surgical bone of a condor the
00:01:31
hands origin point of view just was speeding than romance between than the
00:01:36
romans that case spontaneous pain that's mean passions quite interesting that they
00:01:40
so for these charges all warning paying a spontaneously in front of the other
00:01:44
kind of normal must aromas that is just a a half the problem
00:01:49
when you are moving the handle you are moving they'll ball what what touching
00:01:52
the deep of the singers it's very important to keep in mind
00:01:55
these uh this this this very simple approaches of the of the neural
00:01:59
most of the turning on the wrong all the norms england unity
00:02:02
you know that tune all always the problem that we must solve and
00:02:06
furthermore sometimes that it's very easy to find a imaginable to
00:02:10
to to to to to to to to touching their passions who has a normal but we must be sure that this passions
00:02:17
coming his problem with these uh be you on the on the neural net that we can found it
00:02:22
it's very important in that case as to try to make a
00:02:26
audible block yeah off initially with keeper celine a solution
00:02:30
and play that a couple of lay there with an aesthetic you know to
00:02:34
know a perfectly that this is the cows of the of the
00:02:37
problem of the of the of the of the the robotic thing so what is that uh the the the thing that we can do
00:02:43
the the the hand surgeon can we uh aboard put raymond of patient winner about the problems uh
00:02:49
obviously the the the the the the management of the of the repair the management of the
00:02:55
of the of the switch or the management of the structure that we helped with that
00:02:58
we're treating is one of the most principals it's so important that passions whistle for
00:03:03
and often sections can be referred it kind of just prepare units
00:03:07
that can be solved this problem properly so ah another of
00:03:10
the of of the tools that we have is the neural rises and rises is very important little when is doing
00:03:16
uh accordingly with uh with uh with the findings and accordingly we use
00:03:21
this aggression of the passion not all the passions with nobody pains
00:03:24
needs the same the same uh the same solution is pretty early
00:03:28
expose that that they are more than one hundred fifty that
00:03:31
train as possible so and so we must choose you need you need special
00:03:35
is the best option so yeah i'm in order to simply fine
00:03:39
we suggest that passion school high school has so for the spontaneous
00:03:43
paying that no romance that it's creating a top yeah
00:03:47
most to be reconstructed we can reconstruct disney romance as well with graph with our graph
00:03:53
always conduit in order to try to uh to connect the proximal storm and
00:03:58
these tossed them all in order to create a new new roman
00:04:01
but uh boy to to have a copy and the other and the other cases these passions will has
00:04:06
an aroma within you see paying this this this and this new remote probably just must be
00:04:12
an a protected from the from the steam all's protective from the movement
00:04:16
i'm probably with these men over will be an oft betrayed properly the situation
00:04:21
there are several thing is that we must consider in order to include
00:04:24
in or per share their uh one of those is the inter but is
00:04:28
now recording especially the never action potential in aromas on continued you was
00:04:32
well in aromas and in the terminal never almost it's so useful to
00:04:36
to to know what is the best option that we can do
00:04:39
in our you know surgical prime and this is a buried verify example
00:04:44
this is a a very nice lady saying two years well that's all for a c.
00:04:48
attic injury after i put a hip replacement yeah he's had problem is not
00:04:53
the posse of the and got her problem is the born in pink you suffering all the
00:04:57
day along the length and so when we make an approach of the setting nerve
00:05:01
we we clearly and i'm fine uh uh a nerve here
00:05:06
involved in a yeah yeah very using yes uh i never involve it in
00:05:10
a enough enough you brought to issue for the for the for surgery
00:05:14
and so with that in the bud isn't recording we identify where is the lack of the of the trace
00:05:19
of interaction potential and so just with my turn with narrowed eyes as it's enough to solve this problem
00:05:26
um the young noses of the uh pretty fell no problems it's a very hard stuff to
00:05:31
do um is well now that the regular nerve conduction a study is the the the
00:05:37
direct from your se although letterman narrow daffy just give informations
00:05:41
about the matinee that fibres that's mean uh that
00:05:46
use information about the motor function or some of the sensitivity
00:05:50
but we must remind that i'll explain you this morning
00:05:53
that small fibres it's how they'll tell us if i bus you've responsible mainly of the pain
00:05:59
all of the pain conduction all the pain sensation so uh i recently that
00:06:03
several a test that do we uh that foreplay we have you
00:06:07
know are unique in barcelona that is that she had and did not as a pointed that if this is a very special test
00:06:13
just in order to enable weight but how much of that these small fee was are mainly responsible so
00:06:19
of the of the narrow but deep in problems is very usable that passions issue for um
00:06:26
mm you're about the pain have the nerve conduction are still is completely normal money for good reason
00:06:31
because nerve conduction expose already learned conduction studies just give information about the money that fibres
00:06:37
but this is an example how we working that the uh that the remote estimate is give
00:06:41
you a range of information which is the social of pain and sensation in coal
00:06:48
and in warm and so with these uh with these appalachian
00:06:53
we know perfectly whole woodworking the small five hours
00:06:56
this is an example of the passion we sat there and you don't have injury
00:07:01
can have conduction is still just a regular nerve conduction still was completely normal just
00:07:05
uh we find a small decreases of the potential of all the inching along that bit of it that i
00:07:11
don't i don't have a i at the at the at the new level but with the other
00:07:17
test with the remote this country that even when chips we found clearly they are added munitions or the
00:07:22
option of the function of the small fibres and so on the the surgery we found that
00:07:27
these a large man of the deep trash yeah compressing the pronoun have these here
00:07:32
if you see the or the lack of best quality on the on the net of in
00:07:37
the in the uh in in the setting there so meeker next meeting arises was alone
00:07:41
and this is the the interpretive now regarding where we found it clearly the lack
00:07:46
of the traces of interaction potential so this case where soul but initially because
00:07:51
we have the school of the new technologies of the nerve conduction of studies
00:07:55
on with these abilities net action potential interpreted usually that gives you
00:07:59
the exactly the point what is the compression of the nerve and so what is the support that the what is the x. that
00:08:05
a benefit that we have with the new devices that we have uh that that that we can achieve now
00:08:11
initially we talked briefly about the conduit and uh and and uh and uh and and um and
00:08:17
you have a protectors it's clearly what is the the design out of disk on which is
00:08:22
in initially to to to improve the results in all shorter but there
00:08:26
are some and then if you also when we're treating aerobatic kate
00:08:31
uh this is that the diminishes the that kind of effect on the on how long the never on the on the screen
00:08:38
they uh avoid that i dunno sprouting to the scheme that's mean that his passion because a small
00:08:42
fibres last so fast and so and sometimes that fibres in order did so superficial tends
00:08:48
to go to the to the to the to the approach to the skin and so they're
00:08:53
very often that their passions will has borne that being on the on the spare area
00:08:58
and so did we know she's also this car around the nerve and improve the dating and the movement of the never along
00:09:04
the along the along the uh along the extremity this is a briefcases in order to to try to show you
00:09:10
always the different approaches that we can do on that but if i don't have a pain disorders
00:09:16
and so this is a very frequent cases as sensitive ranch of the of the rodeo
00:09:20
nerve there at the you know in in this car their holiday numbering spontaneous pain
00:09:26
how on that trip prefer harry on the on on the hand and you can find here they are
00:09:31
a big like that on overall might you moving these fast eagles so in this case we
00:09:36
uh i would create a gap with the nova roma i'm we reconstruct with a small
00:09:42
only and at the same time we reconstruct the function of the right you don't have
00:09:46
and we and we use some of the of the of the potential
00:09:49
over of the suppression of these superficial next in order to avoid
00:09:53
that and a sensation of that you know all you per but yeah when you starting around
00:09:57
the the the the idea of this car and we had a i've fat flap
00:10:03
from radio uh from the ideal performance asked heartache in order to give more soft tissue to cover
00:10:08
these effect of the nerve this is another just another situation this is a passion whole ours
00:10:14
treated initially one year before with certain section of the of the the millionaire of the the the repair
00:10:20
of the millionaire was so successful they recover sensitivity of the hand the sender most all is
00:10:25
uh is regarded as well and so they have a scrambled in yeah in the in in the area
00:10:30
of the broadest very often the passion why hon worker they can't stand to work again because
00:10:36
that everything that it's it's falling down on the on the that it's painful for him and so
00:10:41
to resolve this this this this uh this situation we make another approach at the same level
00:10:46
we didn't if i carry what is the new rama of the studio that neural net don't must
00:10:51
be touch it because remember that the function of the nerve it can be recovered it
00:10:55
so we design at the back or a flap you know that to give up
00:10:59
over uh to to to to protect uh the the the these these p.
00:11:03
l. sensation of this cat and we had i never protected in order to avoid
00:11:07
the dispersion of this of the small fee was going to this king
00:11:12
finally did is another situation uh barry often this is a a dorsal
00:11:16
branch a sensitive of the of the of the well known errors
00:11:20
and this is barry suppression have also reports like this now for
00:11:23
this is the boxes times reconstruct this now within our grasp
00:11:27
and we put in the in the both uh the in the both the standard
00:11:30
of the of the structure i over a robbing you know that will boyd
00:11:35
the sensation of that you know again so in this in the situation where a construct the function of the
00:11:40
of the of the sensitivity of the of the do not grind and as well to protect to avoid
00:11:45
to create a ah the stinger sensation of the same level of the of of the
00:11:49
first and with this concept is very important that any time that you will
00:11:55
expect that that potentially you have any problem with this we try to go
00:11:58
over to in order to prevent this this dissertation this is very
00:12:03
frequent situation this is a partial to the position of the of the median nerve
00:12:08
the fast because that's that that uh that give the function of the senate muscle
00:12:12
was involved so partial ball see it happens in the situation one want um
00:12:17
uh after the sort of the the the the injury so that i don't know remote was respected
00:12:23
have you sat here and so i never writing is going at the same time in other to keep
00:12:28
how to to to great the comedy effect and to protect to uh to this bus prodding to that
00:12:33
list keen on disk and useful also in situations with the compression every patient is very usable
00:12:39
this is a couple to know uh seen them uh in just missed source but read it several times before
00:12:45
they are not automatic nova roma but they are very important to rotate issue around
00:12:49
in these these nerve so the spontaneous panel loading it happen in these cases
00:12:54
and so that's that's kind of the approach previously don't use always painful
00:12:59
so in this case here we make the revision we make a
00:13:02
ah wrapping and the section of the of the gaping arises
00:13:06
um and we make a a up over with a white to to pull that was prodding on
00:13:12
the screen and to improve the clean so we had a fight fight as a strickland message
00:13:18
and this is the result that passion decreases the and uh and um the the pain from nine
00:13:25
to four and a half and objectively the function of the sensitivity was improving as well
00:13:30
so finally what is that the role of the lower of the gun will be useful in the treatment of
00:13:34
their about the bank is is the most important thing for us is that they've been use a hat
00:13:40
a berry berry proper disk awful how very pretty entity scuffle
00:13:44
because when you are putting us road accountable graph
00:13:47
remember that is spent yourself that must be a must be a degenerated initially in
00:13:52
order to avoid to to to to grow we'll just prodding of the proximal
00:13:56
us time and so sometimes disease that that the best web station in in
00:14:00
front of that that the these cable solo graph uh perform it before
00:14:07
well this is the case with a passion whistle for burning paying a spontaneous pain on that digital nerve
00:14:13
digital there was a documented weston said that previously we recover we we
00:14:17
we we did this the this gap of the digit don't have
00:14:20
with that kind of a rough that i rough followup was successfully that the passion that area of burning
00:14:26
pain was decreasing uh i'm continuously but at the is very frequent that with passion we have
00:14:33
and boring pain while the near disappears their passion that appears at being all sign a problem of
00:14:39
the at the at the should or whatever so in the space in in this case
00:14:43
it indicated to make a flap also to make up over with a rapping also in order to
00:14:48
protect this thing all sign on the on the hand and this is the final situation
00:14:54
this is a very frequent six situation that that you remember that
00:14:58
then there's always try to be reconnected to the thunderstorm explained you before it is a very trade
00:15:03
example of bass this is an arrow to me labour of the high resting of the
00:15:08
of the sort on every nerve up to to to use the scrabble graph for another reconstruction
00:15:12
of the net but uh i pay attention they here this is the neural tummy level
00:15:16
all the the the the the the the proximal strong ties to be
00:15:20
reconnected the study and tries to crawl does that do to the
00:15:23
the nova roma so in the this is the best option you know that to put on our graph to dual uh initially to
00:15:30
uh reconstruct to to to put these and did does know roman and put another graph at the end of this time you know that
00:15:36
to put these a holographic into the most on in order to
00:15:40
uh to to repair the situation this is another situation
00:15:45
this is i get to jenny poster your t. v. l. injury uh can you appreciate here
00:15:50
clearly hallways the the disorder or the skin that right is keen there are not
00:15:54
a sweeping there are the aspen time you spin on the on the on the on
00:15:59
the planter area so we were we can start with a within our grasp
00:16:03
this is the method that we used to decide what is the base level of the neural
00:16:07
to me with inter but even record is another buddy who put a very useful tool
00:16:12
and so these pay attention the whole these uh area of the small fibres responsible
00:16:18
how the grazing cannot improving if you compare initially with the national situation also we want
00:16:24
expected to reconstruct the function of the of the of the planter muscles in this
00:16:29
in in these needle h. fashion it's very useful tool uh to
00:16:33
trade then or about the pan finally last example this is
00:16:37
but they don't have injury a six weeks after the injury we decided to reconstruct these
00:16:42
long gap with that compound uh with the comp on how to have another
00:16:47
have disease painter but isn't recording this is the proximal storm we decided what is
00:16:52
the best level of the proximal narrow to me in order to put
00:16:55
the grass in the proper situation that there are out uh how life as time proximity
00:17:00
this is the the the compound of the how to graph and how and an hour of proximity and autograph
00:17:06
and this is the reconstruction but here is where we want to pay attention
00:17:10
please because is very important is the situation with our reconstruction at all
00:17:14
is clearly they are are damage on the screen there damage of the autonomic uh um um
00:17:20
quality of the of the all the nerve disease this situation with and i know how to
00:17:26
graph is another passion but pay attention here the dismal fibres you don't works properly
00:17:31
as with these days with how to work with our graph okay you can pay
00:17:35
attention here there the the spinning so dry this being is seen or
00:17:40
they're not the same and desecration of the screen in front of the situation with and
00:17:46
within our graph so they have some benefit is the use of the l. r. f. in order to reconstruct
00:17:52
the uh small fibre so we must we can see that the
00:17:54
results in hand surgery we prefer under surgery we just not
00:17:59
i'm thinking about the motor function it's important that we are thinking about the global function of then or
00:18:04
so which so difficult if you mark if you need to to attend and transferred in that fashion with
00:18:10
complete recover the small fire was in front of the other passions with on father's so
00:18:15
finally just in conclusion that is important to how multi disciplinary approach
00:18:19
it's important to use of the interpreter there's no record in order to decide what is the best redmond for that
00:18:25
no roaming continued you walk out well of the level of zero to me proximity
00:18:29
there are several thing is that we can use not all the cases need the same solution we must
00:18:35
jules from the or tray which is the best will that we can that when when used
00:18:39
other we have it very useful in some cases and especially we must uh to follow up
Conference Program
A-1281 Peripheral nerve repair: where do we stand?
Dominic Power, UK
June 13, 2018 · 1:03 p.m.
312 views
A-1282 Peripheral nerve repair; the conduit option and management of end neuroma's
Tahseen Chaudhry, UK
June 13, 2018 · 1:19 p.m.
208 views
A-1283 Evolution of my Algorithm for treating traumatic peripheral nerve injuries
Bauback Safa, USA
June 13, 2018 · 1:43 p.m.
269 views
A-1303 Evolution of my algorithm for the surgical management of pain
Joaquim Casanas, USA
June 13, 2018 · 2:03 p.m.
146 views