Аssessment of intra-trunk blood flow during operations on peripheral nerves

With a complete anatomical break of the nerve trunk, often, in order to restore its integrity, an epineural suture is performed. The latter, in turn, is inevitably associated with the tension of the nerve trunk in order to overcome the emerging diastasis. As a rule, overcoming diastasis up to 5 cm does not lead to excessive tension of the nerve trunk. Depending on the individual topographic and anatomical relationships of a single nerve trunk, in certain cases, overcoming diastasis even less than 5 cm can be accompanied by a significant tension, which can lead to a violation of its blood supply. In this case, even a perfectly performed epineural suture from a surgical point of view may not lead to positive results. One of the factors of unfavorable outcome of surgical treatment may be a violation of intra-trunk blood flow in the postoperative period.

This article evaluates the possibility of using intraoperative fluorescent angiography in reconstructive surgical interventions on nerves, in order to assess the adequacy and effectiveness of intra-trunk blood flow as one of the factors of the outcome of surgical treatment. During operations for neuropathies of various origins with the presence of neurotmesis, intraoperative fluorescent angiography was performed with simultaneous recording of the tension force. After restoring the integrity of the nerve trunk, repeated fluorescent angiography was performed to assess the safety of adequate effective blood flow. The study found that intraoperative angiography allows you to determine the safety and, equally important, the adequacy and effectiveness of blood flow in the nerve trunk, while being an affordable and easily feasible technique. Thanks to this technique, it becomes possible to assess the quality of the comparison of nerve stumps along the axis, excluding the possibility of their «twist», to study the mechanisms of compensation of blood supply to the nerve after microsurgical epineural suture.

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