Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

2013 WUSTL - Medical Student Lecture

No description
by

Andrew Yee

on 1 November 2015

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of 2013 WUSTL - Medical Student Lecture

Classification of Nerve Injuries
Supercharge
Nerve Transfers
(+)
(+)
Nerve Transfers
I
II
IV
III
V
VI
II Degree
III Degree
donor nerve
near target muscle
expendable donor nerve
donor nerve with "pure" motor fibers
donor nerve with large number of motor axons
donor muscle is synergistic to target muscle
Indications
need to direct a large number of motor axons quickly to denervated muscle

Nerve Transfer provides:
source of nerve in close proximity to the denervated muscle
faster and superior muscle reinnervation
Neuron Cell Body
Muscle / Skin
Schwann Cell
Axon
Nerve Injury
Degeneration
Cell Migration
Axonal Growth
Reinnervation
Nerve Regeneration
Neuron
Window for Reinnervation
Normal
Atrophy
"Irreversible" Atrophy
Time of Injury
0 - 12 Months
12+ Months
1mm / Day
3cm / Month
36cm / Year
"Irreversible" Atrophy
12+ Months
Regeneration Rate
~1mm Growth / Day
3cm Growth / Month
36cm Growth / Year
Distance Time
Time Muscle
Muscle Function
Rat Model - "Irreversible" Atrophy - >1 Month
Atrophy = Functional Deficit
Maximum Tetanic Force (P0) Muscle Muscle (Atrophy)
Muscle
Neuron Cell Body (
Gateway Arch
)
Anchorage, AK
St. Louis, MO
Nerve Injury
and Recovery
Results of Nerve Grafting
Thoracodorsal to Musculocutaneous
Nerve Transfer
Medial Pectoral to Axillary
Nerve Transfer
Muscle
Neuron Cell Body (
Gateway Arch
)
Anchorage, AK
St. Louis, MO
Fairbanks, AK
Adjacent Neuron Fibers
Results of Nerve Transfers
Nerve Transfers
Nerve Injury and Recovery
Nerve Surgery
Credits
Andrew Yee, BS
Peripherial Nerve Surgery Education
nervesurgery.wustl.edu

Surgical Video Library
https://vimeo.com/user6062882

Prezi Presentation
http://prezi.com/user/yeeandrew/
Peripheral Nerve Surgery
Susan E. Mackinnon, MD

Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO
NIH - 5R01 NS 033406-17
Nerve Allotransplantation for Traumatic Nerve Injury
NIH - 2R01NS05170606A1
The Effects of GDNF on Peripheral Nerve Regeneration
I, Susan E Mackinnon, am the co-inventor of the PGA Neurotube and have received research funding from AxoGen Inc.
Anterior Interosseous to Ulnar Motor Nerve Transfer
SUPERCHARGE END-TO-SIDE
Proximal Regenerative Front
Partial Injury Model
2nd/3rd degree injury
Axonotmesis
Supercharge in
Incomplete Model
Partial Injury - Graft
Supercharge Nerve Transfer
Transection
Supercharge in Incomplete Injury
Supercharge in Incomplete Injury
with
Donor

Transection
II.
I.
Additional Regenerative Front
Supercharge Experimental Study
Histomorphometry
End-to-end
Nerve Transfer
Supercharge
Nerve Transfer
=
Incomplete Ulnar Nerve Injury
Orientation
DONOR

- Anterior Interosseous Nerve
RECIPIENT

- Ulnar Motor Fascicle
Anterior Interosseous to Ulnar Motor
Supercharge Nerve Transfer
1-Year Post-operative
AIN
to
Ulnar Motor
SETS Nerve Transfer
Post-operative Results
RESEARCH
CLINICAL
Pre-operative
Post-operative
Cross Facial Nerve Grafting
Gracilis Muscle Harvest
Carpal Tunnel Release
Failed Carpal Tunnel Surgery
Plastic and Reconstructive Surgery
I.
II.
Spinal Accessory to Suprascapular Nerve Transfer
End-to-end
Motor End-to-side
sacrifice lower trapezius
backfill trapezius by reinnervating entire muscle
Donor
Recipient
Recipient
Donor
Donor
Recipient
Neuroectomy
Proximal Crush
Post-operative Results
Motor Branch
Sensory Branch
Femoral Nerve
I.
II.
III.
End-to-side
Proximal Crush
Neurectomy
End-to-side (
Atraumatic
)
End-to-side (
Compression
)
End-to-side (
Epineurotomy
)
Compression
Epineurotomy
Atraumatic
Regenerative Sprouting
Experimental Studies
Transgenic GFP Models
Restoration of Shoulder Function
Spinal Accessory Nerve
C7 (Pectoral)
to
spinal accessory
transfer

Suprascapular Nerve
Spinal accessory
to
suprascapular

transfer

Axillary Nerve
Medial triceps
to
axillary
transfer
Medial pectoral
to
axillary
transfer
Thoracodorsal
to
axillary
transfer

Long Thoracic Nerve
Double-level transfer
C7 (Pectoral)
to
long thoracic
transfer
Thoracodorsal
to
long thoracic
transfer

Intercostal
to
long thoracic
transfer

Medial Triceps to Axillary Nerve Transfer
Motor Transfer
Sensory Transfer
Radial Sensory Component
to
Superior Lateral Cutaneous
Nerve Transfer
Post-operative Results
Medial Triceps
to
Axillary
Nerve Transfer
Spinal Accessory
to
Suprascapular
ETE Nerve Transfer
Radial Nerve Stimulation
Restoration of Elbow Function
Musculocutaneous Nerve
Double fascicular transfer
Thoracodorsal
to
musculocutaneous
transfer
Medial pectoral
to
musculocutaneous
transfer

Triceps Brachii Nerve
Flexor carpi ulnaris
to
medial triceps
transfer

Restoration of Hand Function
Radial Nerve
Median to radial transfer
FDS
to
ECRB
transfer
FCR
to
PIN
transfer
Supinator
to
PIN
transfer

Pronator Teres Nerve
ECRB
to
pronator teres
transfer
FDS
to
pronator teres
transfer
FCR
to pronator teres transfer
FCU
to
pronator teres
transfer

Anterior Interosseous Nerve of Median Nerve
Brachialis
to
anterior interosseous
transfer
ECRB
to
anterior interosseous
transfer
Supinator
to
anterior interosseous
transfer
FDS
to
anterior interosseous
transfer

Flexor Pollicis Longus of Median Nerve
FDS
to
FPL
transfer

Recurrent Thenar Branch of Median Nerve
Anterior interosseous (PQ)
to
recurrent thenar
transfer with graft

Deep Motor Branch of Ulnar Nerve
Anterior interosseous (PQ)
to
ulnar motor
transfer
EDQ / ECU
to
ulnar motor
transfer with graft
MEDIAN
ULNAR
RADIAL
Brachialis to Anterior Interosseous Nerve Transfer
Brachialis
to
AIN/PT
Nerve Transfer
Post-operative Results
Pronation and AIN Function - 2 Years
Pronation and AIN Function - 4 Years
Donor
Recipient
Recipient
Recipient
Recipient
Donor
Recipient
Recipient
Donor
2 Years Post-operative
4 Years Post-operative
Brachialis
to
AIN
Nerve Transfer
Brachialis
to
AIN
Nerve Transfer
Anterior Interosseous Fascicular Nerve Anatomy
Brachialis and Median Nerve
AIN Fascicle
Nerve Transfer
Brachialis
to
AIN
Nerve Transfer
Modified
(N) median
(N) brachialis
(N) AIN fascicle
(N) pronator fascicle
(N) brachialis
(N) AIN fascicle
(N) brachialis
Interfascicular Anatomy of Median Nerve
Interfascicular Anatomy of Median Nerve
Donor
: Brachialis Branch
Recipient
: AIN Fascicle
2 Years Post-Injury
Brachialis to AIN Nerve Transfer
Histomorphometry
Post-operative Results
Functional Recovery - 1 Year
Nerve Fibers: ~3222
Nerve Fibers: ~3512
71 Year-old Male
Spinal Cord Injury: ~C7 Level
Presentation
Pre-operative Examination
Left Arm Examination
Right Arm Examination
2 Years Post-Injury
2 Years Post-Injury
Brachialis to Anterior Interosseous Nerve Transfer
Functional Recovery - 2 Year
Double Fascicular Nerve Transfer
Double Fascicular Transfer
Median and Ulnar Merve Anatomy
FCU Fascicle Stimulation
FCR Fascicle Stimulation
Post-operative Results
Donor
Recipient
Recipient
Donor
Donor
Recipient
Recipient
Donor
Spinal Accessory to Suprascapular Nerve Transfer
(ETS - Anterior Approach)
Types of End-to-Side
Bands of Fontana
Motor Regeneration
End-to-side Regeneration
End-to-side Coaptation
No Injury
End-to-side Coaptation
Proximal Crush Injury
Neurectomy
PROXIMAL CRUSH
NEURECTOMY
Motor End-to-side
SHOULDER
FUNCTION
SHOULDER
FUNCTION
ELBOW
FUNCTION
No Elbow Flexion
Shoulder Deficit
(-) Axillary Nerve
(-) Suprascapular Nerve
(-) Musculocutaneous Nerve
Normal Wrist Flexion
(+) Flexor Carpi Radialis
(+) Flexor Carpi Ulnaris
C5,6 Injury
Shoulder
Nerve Transfers
Restores...
Median and Ulnar Nerve Anatomy
Fascicular Anatomy
Double Fascicular Nerve Anatomy
HAND FUNCTION
SPINAL CORD INJURY
LEFT
Brachialis to AIN Nerve Transfer
RIGHT
Electrical Stimulation of Left AIN Fascicle
Electrical Stimulation of Right AIN Fascicle
Melt My Wings
Outcomes
HAND FUNCTION
NERVE TRANSFERS IN THE
UPPER EXTREMITY
Full transcript