Microsurgery Tutorials. Lesson 16: Microneurorrhaphy With Venous Graft. Rat Saphenous Nerve and Vein

The technique of venous grafting is used to protect a nerve from surrounding tissue after entrapment surgery in order to prevent repeat occurrences of carpal or cubital tunnel syndrome. A longitudinal cut is made on the midline of the proximal hind leg and the saphenous nerve and vein identified as they course distally. The vein is dissected with extreme care as it is small and very easily damaged, even moreso than the inferior vena cava or the femoral vein. The proximal and distal ends are ligated, the vein cut, the field flushed with saline and the vein completely detached from its surrounding fasciae. The microneurorrhaphy is then performed in the regular fashion and due to the very small size of the nerve only 3 knots can be tied. We also show that during flushing and clearing the operating field the vein may become very small and tangled up, not resembling a vein at all, as it is enormously small and thence great care must be put into keeping it in sight at all times. A microscissors of the smallest caliber is used to longitudinally cut the vein which is then placed in a spiral fashion around the nerve with the intima in contact with the epineurium. This is the key step and must be meticulously and with great patience carried out. The graft is then anchored at the ends to the epineurium and each loop of the spiral is attached to the adjacent one via a knot in the middle. The graft is then checked for proper placement and perfect parallel alignment and the skin closed with 7/0 USP round body polyglactin 910 absorbable sutures. Motor function should be very good from the next day should the technique be pristine. More videos to come! Song: Tchaikovsky Marche slave in B-flat minor Op. 31. I do not own or claim authorship for the song. A series of tutorials on microsurgery, starting from the basics working up to more advanced techniques, uploaded in random order. Copyright 2012 Victor Volovici (DrW). Carl Zeiss Opmi Pico Microscope, no colour filter applied, magnification 20x-50x.