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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07-NOVEMBER-2009 SAMER NAEEM AL-KHALILI 39
YEARS CONDITION AFTER CUT RIGHT ULNAR NERVE AFTER REMOVAL OF SCHWANNOMA
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
Thanks to the honesty of the
surgeon that he admitted that he performed
complete cut of the nerve during surgery. If he
did not inform us, we will wait several months
to decide what to do and the the degree of
recovery will be lowered in that case.
The anterior transfer of the
ulnar nerve could supply additional length to
perform anastamosis with 4 cm gap without
The patient came to the
clinic 03-November-2009 complaining of loss of
function of the right ulnar nerve 2 weeks ago
after performing operation for piles and removal
of "lipoma" in the right forearm, which later
was identified as schwannoma. The surgeon
confirmed that there was neural tissue in the
distal and proximal part of the mass.
EMG and ECS performed 2 days
ago confirmed complete nonfunction of the right
ulnar nerve at the middle of the forearm.
On examination: the patient
has complete absence of the sensory territory of
the ulnar nerve above the ramus dorsalis of the
nerve. Clawing of the hand with hypotrophy of
the interossii right hand.
Using IOM Inomed ISIS the
nerve was identified at its proximal and distal
ends. It was completely cut just above the
emergence of the dorsal branch of the nerve and
there is a gap 4 cm. Only the ulnar artery was
intact, which was preserved. Neurolysis of the
distal and proximal parts of the nerve was not
sufficient to regain mobility of the ends to
perform anastamosis, for what it was necessary
to perform anterior transposition of the nerve
at the cubital canal. All the branches emerging
from the nerve and supplying the muscles were
respected and preserved. The nerve was
transferred to run in the subcutaneous space.
After that it was possible to perform
anastamosis with nylon 4 zero with good
Routine closure of the
wounds and the upper
limb fixed with fiberglass above elbow with 90
degrees flexion at the elbow and slight flexion
at the wrist. Smooth postoperative recovery and the patient sent to
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 .