A Bionic Neural Link for peripheral nerve repair.

Peripheral nerve injuries with large gaps and long nerve regrowth paths are difficult to repair using existing surgical techniques, due to nerve degeneration and muscle atrophy. This paper proposes a Bionic Neural Link (BNL) as an alternative way for peripheral nerve repair. The concept of the BNL is described, along with the hypothetical benefits. A prototype monolithic single channel BNL has been developed, which consists of 16 neural recording channels and one stimulation channel, and is implemented in a 0.35-µm CMOS technology. The BNL has been tested in in-vivo animal experiments. Full function of the BNL chip has been demonstrated.

High definition ultrasound as diagnostic adjunct for incomplete carpal tunnel release.

Carpal tunnel syndrome is the most common nerve entrapment in the upper limb and carpal tunnel release (CTR) provides the most predictable outcome and relief of symptoms. Incomplete carpal tunnel releases are uncommon, however, in the event of incomplete surgical releases, symptoms following such incomplete releases tend to be more severe than the symptoms presented at the initial complaint. We present our experience in utilizing high definition ultrasound to reliably and accurately localize the anatomical cause to aid focused revision CTR.

High resolution ultrasonography in the diagnosis of ulnar nerve lesions with particular reference to post-traumatic lesions and sites outside the elbow.

OBJECTIVE: Recent studies suggest that high resolution ultrasonography (HRU) is useful in evaluating ulnar neuropathy (UN) at the elbow. These studies do not include UN outside the elbow and lesions related to previous trauma. We investigate diagnostic utility of HRU in UN at any location of traumatic and non-traumatic etiology. METHODS: Patients with clinically suspected and electrophysiologically defined UN at the elbow and outside the elbow were included. Nerve conduction studies (NCS) were compared with HRU. HRU defined UN in terms of change in cross-sectional area. RESULTS: Our retrospective analysis included 46 UN. In 25 cases both NCS and HRU localised neuropathy to the elbow. In 15 where NCS was abnormal but non-localising, HRU localised the lesion in 14, 7 outside the elbow. In three of these, HRU characterised further pathology (synovial osteochondromatosis (n=2), myositis ossificans (n=1). Cross-sectional area of the ulnar nerve at the sulcus significantly correlated with distal NCS parameters. CONCLUSIONS: HRU is of greater use than NCS in the localisation of UN both at the elbow and outside the elbow and in UN related to previous trauma. SIGNIFICANCE: HRU is useful for the localisation of ulnar neuropathy.

Localised hypertrophic mononeuropathy (LHM) as a complication of peripheral nerve decompression surgery.

Localised hypertrophic mononeuropathy is the progressive enlargement of a large peripheral nerve, which can lead to profound loss of function. In this case report, we describe the postoperative occurrence of this phenomenon and possible ways to monitor for this condition.

Heterodigital vascular island flap for simultaneous resurfacing and revascularization of digits.

Devascularized digits with segmental skin and vessel loss require revascularization and resurfacing. This can be addressed by using a heterodigital vascular island flap. This flap brings with it an appropriately sized pristine artery of optimal length for revascularization and provides simultaneous skin cover. We describe 3 cases. Primary wound healing was achieved in all patients with good functional recovery and acceptable donor site morbidity. We compare the options available for reconstructing such defects and discuss other possible surgical indications for this flap.

Intraoperative interfragmentary radial nerve compression in a medially plated humeral shaft fracture: a case report.

Persistent secondary radial nerve palsy following open reduction and plating of humeral shaft fractures is rare, as the nerve is usually identified and protected throughout surgery. However, it is very difficult to identify and protect the radial nerve during medial and posteromedial approaches and closed intramedullary nailing, thus increasing the risk of damaging it. This case of interfragmentary radial nerve compression at the fracture site occurred during posteromedial plating of a laterally displaced and angulated segmental fracture of the middle and distal thirds of the humeral shaft. Exploration and nerve grafting was later required to regain function. It is important that the radial nerve be identified and protected in fixation of humeral shaft fractures with high-risk fracture configurations.