Atrotech Atrostim PNS Anwenderhandbuch Seite 20

Atrostim PNS Surgical procedure
3 SURGERY OF PERIPHERAL NERVES
Peripheral nerves may be liberated from surrounding tissue and disconnected from
local blood circulation for up to 6 cm of length without losing function, and for
longer distances without losing the ability to fully recover, provided the network of
blood vessels inside the perineurium remains intact (Sunderland 1978). To preserve
the network of blood vessels inside the perineurium it is essential during surgery to
avoid any lesion to the perineurium. If bleeding occurs from the surface of the nerve
during preparation one should try to stop bleeding by compression. Only if necessary
bipolar coagulation may be used by aid of pin-point forceps and with minimum
current. The bleeding vessel should be pulled away from the surface of the nerve
before coagulation current is applied.
4 APPLICATION OF THE ATROTECH ELECTRODE TO THE NERVE
Freeing the nerve from the surrounding tissue
Before application of the electrode matrix,
- incisions are made on both sides of and parallel to the nerve at a distance of 2-3
mm, 1.5 cm (thoracic approach) to 3 cm (approach in the neck) long. The tissue on
both sides is needed to preserve blood supply to the deliberated part of the nerve. If
the incisions are too short, danger of stretching the nerve is apparent during the next
step.
- The nerve is freed from its background by blunt preparation. Avoid stretching. No
bleeding should be allowed to remain.
Application of the matrix
Standard matrix is used in adult patient. Smaller electrode with an extension lead
system is designed for pediatric patients. The direction of the matrix is determined by
the surgeon from the surgical point of view. Once the electrode is fixed the direction
of the cut corner is checked and recorded (whether it is positioned cephalad or
caudal). The numbers in Fig. 8 correspond to the numbers of electrode combinations
in the programming module. It is very important to know the position of the
electrodes in relation to the nerve for possible later trouble shooting. Therefore the
position of the cut edge of the strip should be clearly stated in the Registration Form
B. This way it is easy to determine which strip to reposition in case of a poor or
unstable stimulus response.
11
April 2008