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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 connection.

Comments

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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.

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The anterior transfer of the ulnar nerve could supply additional length to perform anastamosis with 4 cm gap without tension.

 

Anamnesis:

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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.

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EMG and ECS performed 2 days ago confirmed complete nonfunction of the right ulnar nerve at the middle of the forearm.

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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.

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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 cooptation.

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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 the ward.


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