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
The patient 36 years age got gun shot 18
months ago with subsequent paraplegia and anaesthesia below
D9. There was complete absence of spinal cord function below this
level, which was confirmed by ECS and EMG. He underwent recently
operation for major bed sore 1 month ago and huge rotational skin
flap was rotated from the right posterior aspect of the leg. He pass
urine with regular voiding with condom and regular defecation
A detailed discussion about the kind of surgery
and the pros and cons and the limitations of such procedure were
explained to the patient and he was told that despite the final
result, which could be achieved within 3-5 years, he may be in need
for orthoses to make him able to walk. The patient agreed in these
terms and he was operated.
1. As seen in the picture the midline incision is
the less traumatic approach to the postganglionic part of the roots.
Dissection to go around the paraspinal muscles is not wise and cause
more trauma to the soft tissues.
2. The integral part of the operation is not to
cause harm to the patient. For that only functionally unimportant
neural grafts must be harvested and they are at maximum 4 nerves
from each leg: the sural, saphenous, anterior cutaneous branch of
the femoral nerve and posterior cutaneous branch of the sciatic
nerve, which is missing in this case due to previous operation for
the bed sore.