Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
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18-FEBRUARY-2009 ODEH HASAN AL-HAWASHLEH 28 YEARS
RESIDUAL OF GUN SHOT TO THE LEFT SCIATIC NERVE MID THIRD OF THE THIGH.
The patient came to the
clinic 21-January-2009 complaining of complete
loss of function of the left peroneal nerve and
partial impairment of the left tibial nerve
territory after gun shot 7 months ago.
performed several days ago confirmed the
presence of complete denervation of the peroneal
division with partial damage to the tibial
division of the left sciatic nerve.
On examination: the patient
has drop left foot 0/5 and weak planterflexion
left foot 3/5. There is analgesia of the left L5
The left sciatic nerve was
exposed at its superior third and followed
downward. The part with injury level was
dissected off scars. There was neuroma in
continuity felt at the peroneal side of the
nerve. Using the Inomed IIS with EMG and
DNS, the nerve was studied and the
non-functioning fascicles were identified and
splitting of the sciatic nerve was performed
into 2 divisions. During this process some
fascicles were isolated from the non-functioning
part, because they were studied and showed
slight activity with stimulation of 4-7 mA. They
were preserved. The non-functioning part was
studied and even with 10 and higher mA
stimulation there was no response. The scarrous
part of the damaged segment was removed and the
sharp section of this part of the nerve was cut
until good fibers were obtained proximally and
distally. The gap between these stumps was 55
mm. In order to perform cross-anastamosis, it
was necessary to release the proximal and distal
parts of the nerve to regain some extra-length
and the cross anastamosis was performed with the
knee flexion about 40 degrees. Good coaptation
of the stumps and routine closure of the wound
and back slap was applied.
Without using the Inomed IIS,
it was impossible to perform such surgery with
good information about the morphological and
functional status of the bundles. Some of
the bundles were included first with the planned
to to be sacrificed, but studying them, exclude
them from that group. The remaining fibers were
all ending in scar and no fibers were seen in
the cut part of the damaged nerve.
With a gap of 55 mm it was
better to have direct anastamosis of the
peroneal part, than to get sural nerve graft,
because the end result will be inferior in the
case of putting neural bridge.
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Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .