Atrotech Atrostim PNS Anwenderhandbuch Seite 40

Atrostim PNS Surgical procedure for pediatric patients
above the heart. However, in contrast to the unipolar electrode with its large
electrical field between the active and the remote indifferent electrode, the smaller
and only locally appearing electrical field in between the four poles of the Atrotech
electrode allows for a safe short distance to the heart, if necessary. Also, the
four-pole electrode is ideal in cases where a cardiac pacer is used by the patient.
Parallel incisions into the pleura 1.5 cm long are made on both sides of the nerve. A
tunnel is created by blunt preparation behind the nerve. During the following fixation
of the electrode care must be taken not to puncture the caval vein or aorta.
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 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.
In small children only a curved surface may be available for placement of the
electrode. Under such circumstances cutting the bridge of the electrode might
prevent unnecessary tension between electrode matrix and tissue.
9
April 2008