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Peripheral nerve injuries
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
Morbidity from loss of function at the donor site must be acceptable to the patient; hence donors are characteristically sensory nerves. Commonly used donor sites include: Sural nerve.Lateral cutaneous nerve of forearm.Medial cutaneous nerve of arm/forearm.Superficial radial nerve.Supraclavicular nerves.
Low rate of secondary surgery and implant removal following superior, precontoured plating of midshaft clavicle fractures
Published in Baylor University Medical Center Proceedings, 2023
Patrick M. Ryan, Charlie Wilson, Randy Volkmer, Garret Hisle, Michael Brennan, Daniel Stahl
In terms of surgical technique, the patient is positioned supine on a radiolucent table. An incision is made over the superior aspect of the clavicle, centered over the fracture site. After incision through the skin, the platysma is identified. Visible supraclavicular nerves are identified and spared, if possible. Electrocautery is used to incise the platysma and periosteum in a continuous, full-thickness layer down to bone. The fracture site is exposed while minimizing periosteal stripping. An interfragmentary screw is utilized on appropriate fracture patterns. A precontoured 3.5 mm locking plate (Stryker VariAx Clavicle Plating System, Stryker Corporation, Kalamazoo, MI) is placed superiorly on the clavicle. Plate contouring is rarely necessary. Typically, three to four bicortical screws are placed medial and lateral to the fracture site. Satisfactory fracture reduction and hardware position are confirmed using biplanar image intensification. After thorough irrigation, the wound is closed in a layered fashion, using 0-Vicryl suture in single periosteal-fascial-platysma layer followed by 2-0 Vicryl and 3-0 nylon or Monocryl for the subcutaneous tissue and skin, respectively. Postoperatively, patients were non–weight bearing for 6 weeks with allowed active and passive range of motion of the shoulder and elbow as tolerated.
Post-traumatic glomus tumor of the left anterior supraclavicular nerve: a case report
Published in Neurological Research, 2023
Alessandra Turrini, Guido Staffa, Giulio Rossi, Crescenzo Capone
Because of the disabling pain, we proposed to attempt surgery to remove the lesion. On surgical exploration under general anesthesia, the sensitive branch of the left medial supraclavicular nerve ended in a hard mass, apparently in continuity with an ectatic left transverse cervical artery (Figure 2a). The accessory nerve was not involved but in close anatomical relation with it (Figure 2b). Due to the resemblance to a thrombosed pseudoaneurysm related to a traumatic neuroma, the arterial branches were ligated and the lesion was radically excised. Histopathological evaluation showed a mesenchymal neoplasm with both spindle and epithelial cells, some mitotic Figures (1–2 x 10 HPF), and absence of necrosis (Figure 3a,b). Immunohistochemistry stain highlighted a heterogeneous labeling index Ki67 of 4% and positivity of actin-ML and collagen type IV (Figure 3c–e). Despite the preoperative suspicion and the intraoperative appearance, the histological examination revealed a glomangiomyoma. An uneventful postoperative recovery was noted and the painful symptoms promptly regressed after surgery. No recurrence has occurred after 18 months of follow up.
Sensory preservation in neck dissection: outcomes of a sub-sternocleidomastoid approach
Published in Acta Oto-Laryngologica, 2018
Keigo Honda, Ryo Asato, Jun Tsuji, Masakazu Miyazaki, Shinpei Kada, Yukiko Kataoka, Akiko Taura, Mami Morita
Tactile skin sensation was evaluated within 1 week of surgery. Based on the course of cutaneous branches of CNs, four anatomical areas were tested: the tip of the ear tab (for greater auricular nerve); submandibular area approximately 2 cm lower than the edge of mandibular bone and 3 cm anterior to the mandibular angle (for transverse CN); lateral neck area approximately 1/3 of the height of neck along the posterior edge of the SCM (for upper branches of supraclavicular nerves); and the sub-clavicular area approximately 3 cm lower than mid-clavicular point (for lower branches of supraclavicular nerves) (Figure 3). The tip of a thin cotton swab was placed lightly on the skin and oscillated slowly to check the tactile sensation of the patient. Sensation was recorded as ‘preserved’ or ‘lost’. If sensation was impaired but present, the result was recorded as ‘preserved’. Sensory preservation rates were calculated in each tested area. Sensory outcomes were compared between necks with ‘CN rootlet-preserved’ and ‘CN rootlet-resected’ to verify the fundamental importance of CN rootlets. Following this, we evaluated whether the ‘sub-SCM approach’ had more favorable results when compared with the conventional ‘subplatysmal approach’ in CN rootlet-preserved neck dissections.