Academic literature on the topic 'Delayed nerve reconstruction'
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Journal articles on the topic "Delayed nerve reconstruction"
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LAWSON, G. M., and M. A. GLASBY. "A Comparison of Immediate and Delayed Nerve Repair Using Autologous Freeze-Thawed Muscle Grafts in a Large Animal Model." Journal of Hand Surgery 20, no. 5 (1995): 663–700. http://dx.doi.org/10.1016/s0266-7681(05)80131-7.
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Freeze-thawed muscle grafts (FTMG) have been suggested as an alternative to nerve grafts in reconstruction of peripheral nerve defects. This study compares the results of immediate and delayed nerve repair with freeze-thawed muscle graft in a large animal model. Under general anaesthesia, ten adult sheep underwent excision of 3 cm of the right median nerve. Five had immediate nerve reconstruction with FTMGs (Group A) and five were repaired after 4 weeks (Group B). At 6 months, both the right (repaired) and left (“control”) median nerves of each sheep were assessed. Nerve blood flow distal to the graft in both groups of repaired nerves was approximately 60% of that in their respective control nerves. Peak nerve conduction velocities were significantly slower in the repaired nerves. The mean fibre diameters of the immediate and delayed repairs were 5.06 and 3.90 μ respectively compared to a control mean of 8.58 μ. G-ratios confirmed that the repaired nerves in both groups were well myelinated. The authors conclude that the FTMG can be used in delayed as well as immediate nerve reconstruction with minimal impairment of final results.
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Stenberg, Lena, Maria Stößel, Giulia Ronchi, et al. "Regeneration of long-distance peripheral nerve defects after delayed reconstruction in healthy and diabetic rats is supported by immunomodulatory chitosan nerve guides." BMC Neuroscience 18, no. 1 (2017): 53. https://doi.org/10.1186/s12868-017-0374-z.
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<strong>Background: </strong>Delayed reconstruction of transection or laceration injuries of peripheral nerves is inflicted by a reduced regeneration capacity. Diabetic conditions, more frequently encountered in clinical practice, are known to further impair regeneration in peripheral nerves. Chitosan nerve guides (CNGs) have recently been introduced as a new generation of medical devices for immediate peripheral nerve reconstruction. Here, CNGs were used for 45 days delayed reconstruction of critical length 15 mm rat sciatic nerve defects in either healthy Wistar rats or diabetic Goto-Kakizaki rats; the latter resembling type 2 diabetes. In short and long-term investigations, we comprehensively analyzed the performance of one-chambered hollow CNGs (hCNGs) and two-chambered CNGs (CFeCNGs) in which a chitosan film has been longitudinally introduced. Additionally, we investigated in vitro the immunomodulatory effect provided by the chitosan film.<strong>Results: </strong>Both types of nerve guides, i.e. hCNGs and CFeCNGs, enabled moderate morphological and functional nerve regeneration after reconstruction that was delayed for 45 days. These positive findings were detectable in generally healthy as well as in diabetic Goto-Kakizaki rats (for the latter only in short-term studies). The regenerative outcome did not reach the degree as recently demonstrated after immediate reconstruction using hCNGs and CFeCNGs. CFeCNG-treatment, however, enabled tissue regrowth in all animals (hCNGs: only in 80% of animals). CFeCNGs did further support with an increased vascularization of the regenerated tissue and an enhanced regrowth of motor axons. One mechanism by which the CFeCNGs potentially support successful regeneration is an immunomodulatory effect induced by the chitosan film itself. Our in vitro results suggest that the pro-regenerative effect of chitosan is related to the differentiation of chitosan-adherent monocytes into pro-healing M2 macrophages.<strong>Conclusions: </strong>No considerable differences appear for the delayed nerve regeneration process related to healthy and diabetic conditions. Currently available chitosan nerve grafts do not support delayed nerve regeneration to the same extent as they do after immediate nerve reconstruction. The immunomodulatory characteristics of the biomaterial may, however, be crucial for their regeneration supportive effects.
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Qiu, Cecil S., Philip J. Hanwright, Nima Khavanin, and Sami H. Tuffaha. "Functional reconstruction of lower extremity nerve injuries." Plastic and Aesthetic Research 9, no. 3 (2022): 19. http://dx.doi.org/10.20517/2347-9264.2021.126.
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Peripheral nerve injuries (PNI) in the lower extremity are an uncommon but highly morbid condition. Recent advances in our understanding of nerve physiology and microsurgical techniques have inspired renewed faith in nerve surgery and sparked a creative renaissance in the tools, approaches, and reconstructive schemas available to surgeons in the management of lower extremity PNIs. In this article, we review the literature and provide a principles-based approach for the surgical management of lower extremity PNIs with an emphasis on techniques for functional reconstruction after complete nerve injury. General principles in management include early diagnosis with electrodiagnostics and imaging, early surgical exploration, and opting for nerve and tendon transfers when primary reconstruction of the injured nerve is unfavorable (e.g., delayed reconstruction, unavailability of proximal or distal nerve stumps, or long regenerative distance). The goal of functional reconstruction should be to restore independent gait, so understanding the roles of major neuromuscular units during the gait cycle informs the selection of donor nerves and tendons for transfer. Based on these principles and literature to date, specific algorithms for surgical management are presented for femoral, sciatic, tibial, and common peroneal nerves. We recognize limitations of the current literature, namely the predominance of case series evidence, and call for the accrual of more patient data in surgical management of PNIs.
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Head, Linden K., Anne Lui, Erin Cordeiro, and Kirsty U. Boyd. "National Multidisciplinary Survey of Regional Anesthesia Preferences in Breast Reconstruction." Plastic Surgery 28, no. 2 (2020): 105–11. http://dx.doi.org/10.1177/2292550320925551.
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Background: The purpose of this work was to determine the regional anesthesia preferences of plastic surgeons (PS) and anesthesiologists (A) involved in breast reconstruction in Canada. Methods: Online surveys were sent to members of the Canadian Society of Plastic Surgeons (CSPS) and the Canadian Anesthesiologists Society (CAS). The primary outcome was regional anesthesia preferences in breast reconstruction (delayed, immediate, alloplastic, autologous). Secondary outcomes included the availability and the influence of specialty and academic status on preferences. Statistical analysis used descriptive statistics and Pearson χ2 test. Results: Responses from CSPS and CAS totaled 141 (response rate = 30%) and 217 (response rate = 14%), respectively. Compared with non-academic centres (NAC), academic centres (AC) had significantly greater access to (AC = 60%, NAC = 39%, P = .001) and preferred to use regional anesthesia more often (AC = 36%, NAC = 10%, P < .001). The following proportions of physicians preferred to use regional anesthesia: 40% (PS = 32%, A = 44%, P = .081) for immediate alloplastic reconstruction, 23% (PS = 24%, A = 22%, P = .821) for delayed alloplastic reconstruction, 34% (PS = 18%, A = 41%, P < .001) for immediate autologous reconstruction, and 19% (PS = 13%, A = 21%, P = .195) for delayed autologous reconstruction. Regional anesthesia preferences were significantly different between plastic surgeons and anesthesiologists ( P < .001)—anesthesiologists favoured paravertebral blocks for all reconstructions, while plastic surgeons favoured pectoral nerve blocks for immediate alloplastic reconstruction and intercostal nerve blocks for all other reconstructions. Conclusions: Plastic surgeons and anesthesiologists prefer not to use regional anesthesia in the majority breast reconstructions. Among those who deploy regional anesthesia, plastic surgeons and anesthesiologist have divergent preferences with respect to modality. There is a need for a prospective study comparing paravertebral blocks and intercostal nerve blocks.
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Pondaag, Willem, and Martijn J. A. Malessy. "The Evidence for Nerve Repair in Obstetric Brachial Plexus Palsy Revisited." BioMed Research International 2014 (2014): 1–11. http://dx.doi.org/10.1155/2014/434619.
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Strong scientific validation for nerve reconstructive surgery in infants with Obstetric Brachial Plexus Palsy is lacking, as no randomized trial comparing surgical reconstruction versus conservative treatment has been performed. A systematic review of the literature was performed to identify studies that compare nerve reconstruction to conservative treatment, including neurolysis. Nine papers were identified that directly compared the two treatment modalities. Eight of these were classified as level 4 evidence and one as level 5 evidence. All nine papers were evaluated in detail to describe strong and weak points in the methodology, and the outcomes from all studies were presented. Pooling of data was not possible due to differences in patient selection for surgery and outcome measures. The general consensus is that nerve reconstruction is indicated when the result of nerve surgery is assumedly better than the expected natural recovery, when spontaneous recovery is absent or severely delayed. The papers differed in methodology on how the cut-off point to select infants for nerve reconstructive surgical therapy should be determined. The justification for nerve reconstruction is further discussed.
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Morgan, Scott D., and John R. Zuniga. "Nerve Grafting in Head and Neck Reconstruction." Facial Plastic Surgery 36, no. 06 (2020): 737–45. http://dx.doi.org/10.1055/s-0040-1721106.
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AbstractIn head and neck reconstructive surgery, especially of the mandible, the long-span processed nerve allograft (PNA) is a technological advancement that provides improved quality of life for patients who require ablative surgery by allowing for functional sensory recovery (FSR) in the majority of patients treated with immediate reconstruction. Recently published clinical prospective and retrospective multisite controlled cohort studies of immediate nerve reconstruction at the time of ablative surgery, including pediatric patient populations, were reviewed for valid and predictable outcomes of FSR following the reconstruction of the inferior alveolar nerve using > 5-cm PNA allografts. Both adult and pediatric patients demonstrate high percentages of FSR within 1 year. Pediatric patients demonstrate robust recovery with 100% reaching FSR within 1 year, whereas 89% of adults achieved FSR during the same time span; the pediatric patient population reached FSR earlier when compared with adults. Control, nonallograft nerve repair patients never achieved FSR, reaching only S2 levels in both adults and pediatric groups. There were no adverse events; in fact, no patients demonstrated the occurrence of neuropathic pain when the nerve repair was performed immediately in contrast to delayed repair states. Long-span (> 5-cm) nerve allografts provide FSR in pediatric patients and the majority of adult patients and should be used in patients who require ablation of the mandible for head and neck reconstruction.
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Moor, Beat K., Mathias Haefeli, Samy Bouaicha, and Ladislav Nagy. "Results after delayed axillary nerve reconstruction with interposition of sural nerve grafts." Journal of Shoulder and Elbow Surgery 19, no. 3 (2010): 461–66. http://dx.doi.org/10.1016/j.jse.2009.07.011.
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Wan, Hong, Liwei Zhang, Stephane Blanchard, et al. "Combination of hypoglossal-facial nerve surgical reconstruction and neurotrophin-3 gene therapy for facial palsy." Journal of Neurosurgery 119, no. 3 (2013): 739–50. http://dx.doi.org/10.3171/2013.1.jns121176.
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Object Facial nerve injury results in facial palsy that has great impact on the psychosocial conditions of affected patients. Reconstruction of the facial nerve to restore facial symmetry and expression is still a significant surgical challenge. In this study, the authors assessed a hypoglossal-facial nerve anastomosis method combined with neurotrophic factor gene therapy to treat facial palsy in adult rats after facial nerve injury. Methods Surgery consisted of the interposition of a predegenerated nerve graft (PNG) that was anastomosed with the hypoglossal and facial nerves at each of its extremities. The hypoglossal nerve was cut approximately 50% for this anastomosis to conserve partial hypoglossal function. Before their transplantation, the PNGs were genetically engineered using lentiviral vectors to induce overexpression of the neurotrophic factor neurotrophin-3 (NT-3) to improve axonal regrowth in the reconstructed nerve pathway. Reconstruction was performed after facial nerve injury, either immediately or after a delay of 9 weeks. The rats were followed up for 4 months postoperatively, and treatment outcomes were then assessed. Results Compared with the functional innervation in control rats that underwent facial nerve injury without subsequent treatment, functional innervation of the paralyzed whisker pad by hypoglossal motoneurons in rats treated 4 months after nerve reconstruction was evidenced by the retrograde transport of neuronal tracers, the recording of muscle action potentials conducted by the PNG, and the recovery of facial symmetry. Although a better outcome was observed when reconstruction was performed immediately after facial nerve injury, reconstruction with NT3-treated PNGs significantly improved functional reinnervation of the paralyzed whisker pad even when implantation occurred 9 weeks posttrauma. Conclusions Results demonstrated that hypoglossal-facial nerve anastomosis facilitates innervation of paralyzed facial muscle via hypoglossal motoneurons without sacrificing ipsilateral hemitongue function. Neurotrophin-3 treatment through gene therapy could effectively improve such innervation, even after delayed reconstruction. These findings suggest that the combination of surgical reconstruction and NT-3 gene therapy is promising for its potential application in treating facial palsy in humans.
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Cavadas, Pedro C., and Magdalena Baklinska. "Facial Nerve Reconstruction with Free Vascularized Composite Nerve Flap from Intrapetrous Portion to Terminal Branches—Case Report." Indian Journal of Plastic Surgery 54, no. 02 (2021): 204–7. http://dx.doi.org/10.1055/s-0041-1729667.
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AbstractThe case presented here is a delayed reconstruction of a facial nerve defect after radical parotidectomy without a useful nerve stump at the stylomastoid foramen. A composite free flap was used to reconnect the nerve’s intrapetrous portion to the peripheral branches and reconstruct the soft-tissue deficit.
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Liu, Song, Stephane Blanchard, Stephanie Bigou, Sandrine Vitry, Delphine Bohl, and Jean-Michel Heard. "Neurotrophin 3 Improves Delayed Reconstruction of Sensory Pathways After Cervical Dorsal Root Injury." Neurosurgery 68, no. 2 (2011): 450–61. http://dx.doi.org/10.1227/neu.0b013e318200512f.
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Abstract BACKGROUND: Spinal root avulsion, or section, results in devastating functional sequels. Whereas reconstruction of motor pathways based on neurotization can reduce motor deficit, associated permanent limb anesthesia limits expected benefit. Sensory pathway reconstruction after dorsal root injury is limited by the inability of re-growing central sensory axons to enter the spinal cord through an injured root. OBJECTIVE: To provide evidence for the reconnection of C7 DRG neurons with the central nervous system (CNS) after experimental section of the C7 dorsal root in adult rats. METHODS: We assessed a new reconstruction strategy in adult rats 9 weeks after transection of C6 and C7 dorsal roots. Re-growing C7 central sensory axons were redirected to the noninjured C5 dorsal root through a nerve graft by end-to-side anastomosis that did not alter the C5 conduction properties. In a subgroup of rats, surgical reconstruction was combined with lentivirus-mediated gene transfer to the nerve graft in order to overexpress neurotrophin 3 (NT-3), a neurotrophic factor that stimulates sensory axon regeneration. RESULTS: Four months after reconstruction, recording of sensory evoked potentials and fluorescent tracer transport showed electrical and physical reconnection of the C7 dorsal root ganglion neurons to the spinal cord through the reconstructed pathway. Sensory perception recovery predominated on proprioception. Axonal regrowth and perception were improved when the nerve graft overexpressed neurotrophin-3 at the time of transplantation. Neurotrophin-3 overexpression did not persist 4 months after transplantation. CONCLUSION: Efficient and functional reconnection of dorsal root ganglion neurons to the spinal cord can be achieved in rats several weeks after cervical dorsal root injury. Surgical repair of sensory pathways could be considered in combination with motor nerve neurotization to treat persisting severe upper limb disability in humans.
Books on the topic "Delayed nerve reconstruction"
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Heinen, Christian, and Thomas Kretschmer. Iatrogenic Peripheral Nerve Injury. Edited by Meghan E. Lark, Nasa Fujihara, and Kevin C. Chung. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190617127.003.0028.
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Iatrogenic nerve lesions are frequently neglected. The chapter stresses the importance of adequate assessment, surgical timing, surgical strategies, follow-up, and results. Using the example of a radial nerve lesion in discontinuity due to osteosynthesis after humeral fracture, the authors describe a typical patient history with delayed presentation, as well as the role of physical examination, electrophysiology, and high-resolution ultrasound in demonstrating substantial nerve damage incompatible with spontaneous recovery. Surgical findings are demonstrated, along with a stepwise approach for nerve reconstruction via sural nerve graft. Clinical approach and surgery for traumatic radial nerve lesions are detailed, as well as general information on iatrogenic nerve lesions.
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Tse, Raymond, and Angelo B. Lipira. Neonatal Brachial Plexus Palsy. Edited by Meghan E. Lark, Nasa Fujihara, and Kevin C. Chung. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190617127.003.0023.
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Neonatal brachial plexus palsy occurs in approximately 1 in 1000 live births. The extent of involvement and severity of injury are variable. The chapter discusses assessment, nonsurgical treatment, and surgical treatment of neonatal brachial plexus palsy. The approach to surgical exploration is detailed and a number of scenarios are presented so that the principles of primary nerve reconstruction (including nerve graft and nerve transfers) can be illustrated. The scenarios include upper plexus injury, pan-plexus injury, multiple root avulsions, isolated deficits, delayed presentation, and failed reconstruction. Technical details of nerve grafting and nerve transfers are described. Secondary musculoskeletal consequences of brachial plexus palsy are also discussed, including strategies for prevention and options for secondary surgical reconstruction.
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Nadi, Mustafa, and Rajiv Midha. Adult Total Brachial Plexus Injury. Edited by Meghan E. Lark, Nasa Fujihara, and Kevin C. Chung. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190617127.003.0021.
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Total brachial plexus injury (BPI) typically results from high-energy vehicular accidents, affects mostly young adult males, and produces a flail, insensate limb. Because of the association of total BPI with head and cervical spine injuries, diagnosis might be delayed. Recognizing patients with total BPI and using electrodiagnostic and imaging tests in a timely fashion are critical. Advances in microsurgical techniques, primary nerve transfer, appropriate nerve graft utilization from a remaining intact (often C5) spinal nerve root, and free muscle transfers have improved outcomes. However, limited recovery even after reconstruction and severe deafferentation pain both remain challenging problems that further advancements will need to overcome.
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Sabapathay, S. Raja, and Roderick Dunn. Reconstruction. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198757689.003.0007.
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The principles of upper limb reconstruction are to perform careful wound excision, fix the skeleton, reconstruct vessels, nerves, tendons, and bone as required (either immediate or delayed), and to obtain primary healing of the soft tissues with healthy vascularized tissue. This enables early movement—ideally, supervised by hand therapists—and generally results in a good outcome. In particular, delayed healing and immobility can lead to long-term morbidity. We provide a general overview of the principles of surgical incisions in the hand, wound care, and suturing, and discuss the use of skin grafts and flaps in the upper limb. We describe reconstruction of the different areas of the upper limb, along with detailed sections on digital and thumb reconstruction.
Book chapters on the topic "Delayed nerve reconstruction"
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Bains, Robert, and Simon Kay. "Nerve grafts and transfers." In Oxford Textbook of Plastic and Reconstructive Surgery. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780199682874.003.0042.
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Following Cruickshank’s (1795) ingenious (and at first disbelieved) demonstration of the regenerative capacity of mammalian nerves, the eighteenth and nineteenth centuries saw a pan-European enthusiasm to redress the nihilism surrounding nerve injury. The first recorded experimental nerve grafts were performed by Philipeaux and Vulpian who attempted both nerve autografting as well as allografting in dogs. At that time, and for many years, allografts were thought to behave similarly to autografts, a belief that persisted well into the twentieth century in some clinics and laboratories. These early attempts at nerve grafting yielded poor results and most surgeons aimed for primary nerve repair despite nerve gaps. Other techniques to allow direct repair involved alteration of position, transposition of the nerve, and even sometimes bone shortening. Although primary repair was frequently possible, after these measures the repair was under tension and mechanical failure was common. Spurling (1945), Whitcomb (1946), and Woodall (1956) showed failure rates of 4%, 7.5%, and 22.4% respectively. Some recovery of function following nerve grafting was documented by Sanders (1942), Seddon (1954), and Brooks (1955). Millesi subsequently published his results for nerve grafting for injuries to the upper limb in 1984. These papers demonstrated more significant recovery of function and highlighted the detriment of delay in treatment to final outcome. Microsurgical advances were central to Millesi’s results, and he emphasized atraumatic dissection and the deleterious effect of tension at the repair site resulting in fibrosis preventing axonal regrowth. Nerve autograft is now the standard for orthotopic nerve reconstruction when primary repair cannot be achieved.
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Uzcategui, Nicolas. "Eyelid Lacerations and Acute Adnexal Trauma." In Surgery of the Eyelid, Lacrimal System, and Orbit. Oxford University Press, 2011. http://dx.doi.org/10.1093/oso/9780195340211.003.0005.
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When evaluating a patient who has sustained any type of trauma, life-threatening injuries should be addressed or ruled out before proceeding with assessment for ocular and adnexal trauma. In the setting of trauma the practitioner must never forget the basics of life support and systemic trauma assessments. The first goals are to maintain a patent airway and to provide respiratory support. Adequate circulation and perfusion need to be reestablished once an airway has been established. The nature of the accident should alert the practitioner as to the possibility of a cervical spine injury. In accidents that are unwitnessed, that produce loss of consciousness, and/or that are produced by high-velocity impacts to the head, face, and neck, the patient should have C-collar stabilization/immobilization until the cervical spine can be cleared both radiologically and clinically. Only then should ocular and adnexal injuries be assessed. Adnexal trauma is addressed only after the integrity of the globe and intraocular contents has been confirmed by a complete eye examination. A dilated funduscopic examination can be deferred for a reasonable amount of time if a neurologic injury and central nervous system compromise is suspected, since the use of mydriatic agents is a relative contraindication in these circumstances. If a facial nerve injury is not present and/or a ruptured globe has been excluded, the extent of the eyelid and adnexal injuries can be safely determined. Complex lacerations of the eyelid often include extensive wounds involving the eyelid margin, canaliculi, and lateral canthus; these can be associated with tissue loss and can be caused either by sharp objects or bite injuries. In general it is preferable to repair soft tissue injuries within hours of their occurrence; nevertheless, special considerations can delay the primary repair in exceptional circumstances such as severe tissue edema, active infection at the wound site, or extensive hematomas. Intermittent ice compresses, drainage of hematomas, and systemic steroids and/or antibiotics can be instituted prior to repair if swelling or infections limit the possibility of reconstruction. Local wound care and sometimes topical antibiotics are a cornerstone of management in adnexal injury.
Conference papers on the topic "Delayed nerve reconstruction"
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Lovasik, John V., Hélène Kergoat, Pierre Forcier, Robert Wojciechowski, and Etty Bitton. "Topographic and Hemodynamic Changes in the Optic Nerve Head in Humans Subsequent to Experimental Modulation of the Intraocular Pressure." In Vision Science and its Applications. Optica Publishing Group, 1995. http://dx.doi.org/10.1364/vsia.1995.sua3.
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The attrition of nerve fibers in the peripapillary area and the optic nerve head (ONH) in glaucoma has been attributed to mechanical compression of, or aberrant blood flow to the ganglion cell axons comprising the optic nerve1. Recently, greater attention has been focussed on the vascular factors in glaucoma2. Much of the delay in understanding the pathophysiology of glaucoma has been the absence of clinically usable instruments for reliably quantifying subtle structural changes in the ONH, and blood flow in the optic nerve. Fortunately, Petrig and Riva recently demonstrated the applicability of laser doppler principles for measuring blood flow in the ONH in man3, and confocal imaging principles have been adapted for computer reconstruction of serial laser scanned planes of the ophthalmoscopically visible ONH to provide highly accurate and reliable three-dimensional images4 for fundamental/clinical research.