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TEDx Women - Peripheral Nerve - 6

v6
by

Andrew Yee

on 28 August 2014

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Transcript of TEDx Women - Peripheral Nerve - 6

WHO
WHERE
WHAT
WHEN
PASSIO
PASSION
SUFFERING, ENDURING
1mm / Day
3cm / Month
36cm / Year
"Irreversible" Atrophy
12+ Months
Regeneration Rate
3cm Growth / Month
36cm Growth / Year
PERIPHERAL
NERVE
NERVE
GRAFTING
ERICSSON
EXPERTISE
10,000 HOUR RULE
PUSHING THE ENVELOPE
HAVING A COACH
LOGAN
ENVIRONMENT
STAGE 1
STAGE 2
STAGE 3
STAGE 4
STAGE 5
STAGE 4
JOHNSON
IDEAS
ADJACENT POSSIBILITY
SLOW HUNCH
LIQUID NETWORKS
FAILURE
EXAPTATIONS
SERENDIPITY
KUHN
PARADIGMS
CONTROVERSY
PARADIGMS
Muscle Atrophy
Long Distance
Results of Nerve Grafting
NERVE
TRANSFERS
CLINICAL
RESEARCH
Seddon Sunderland
Leonard Goldner
Sterling Bunnell
James Murray
William Littler
Hanno Millesi
Alan Hudson
NERVE
GRAFTING
TENDON
TRANSFERS
NERVE
REPAIRS
NERVE
TRANSFERS
Susan Mackinnon
POOR RESULTS OF NERVE GRAFTING
BRACHIAL PLEXUS INJURIES
Nerve Allotransplantation
Transgenic Models
Histomorphometry
Muscle Force Measurement
Walking Track Analysis
Retrograde Labeling
Microscopic Analysis
Operating Microscope
Fluroscenct Microscope
Confocal Microscope
Light Microscope
Electron Microscope
Translational Research
Piecing a puzzle together...
Motor Branch
Sensory Branch
Femoral Nerve
End-to-side Coaptation
Proximal Crush Injury
Neurectomy
(N) AIN fascicle
(N) pronator fascicle
(N) median
Internal Neurolysis
Lewis (Host) - Lewis (Graft)
Lewis (Host) -
Fisher (Graft)
Lewis (Host) -
ACI (Graft)
1990s
1978
First allograft paper...
"Quantitative Immunological Study"
Developing a nerve allograft model...
...with host immunosuppression.
Lewis / Lewis Autograft
Lewis / ACl Allograft
with
Steroid (Hydrocortisone)
Lewis / ACl Allograft
with
No Immunosuppression
NERVE
TRANSFERS
Interfascicular Anatomy
Results of Nerve Transfers
Medial Pectoral to Musculocutaneous
Nerve Transfer
Thoracodorsal to Axillary
Nerve Transfer
Double Fascicular Nerve Transfer
Post-operative Results
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...
Double Fascicular Nerve Transfer
Post-operative Results
Functional Recovery - 1 Year
Brachialis to Anterior Interosseous Nerve Transfer
Functional Recovery - 2 Year
SPINAL CORD INJURY
Melt My Wings
Outcomes
HAND FUNCTION
SURGERY
SURGERY
DONOR
RECIPIENT
ADJACENT POSSIBILITY
Paradigm Shift
Paradigm Shift
Paradigm
Paradigm Shift
Paradigm
Paradigm
Paradigm Shift
Stage 1 - "Life sucks"
Stage 2 - "My life sucks"
Stage 3 - "I am great, you are not"
Stage 4 - "We are great, they are not"
Stage 5 - "Life is great"
Desmond Tutu
10,000 HOUR RULE
Muscle
Neuron Cell Body (
Gateway Arch
)
Anchorage, AK
St. Louis, MO
Nerve Injury
and Recovery
Muscle
Neuron Cell Body (
Gateway Arch
)
Anchorage, AK
St. Louis, MO
Fairbanks, AK
Adjacent Neuron Fibers
Nerve Transfers
Hours of Musician's Cumulative Practice (by age 20)
Expert 10,000 hours
Second Tier 5,000 hours
Serious Amateur 2,000 hours
Dedicated and repeated practice = deliberate practice
10,000 HOUR RULE
Adjacent Possible
Present Idea
Adjacent Possible
Adjacent Possible
Find ways to explore the edges of possibility that surround you...
ADJACENT POSSIBILITY
~1mm Growth / Day
Nelson Mandela
Truth and Reconciliation Commission
Nerve Repairs
Nerve Grafting
Nerve Transfers
Pre-operative Exam
NERVE
REPAIRS
BREAD AND HEART
Full transcript