One of the prerequisites for an appropriate nerve repair in case of peripheral nerve
injury is to have well prepared and viable cut ends of the nerve to be repaired. The
conventional method[[1]] of holding the cut ends of the nerve with forceps and using an 11 number blade
or a micro scissors supporting the nerve with the spatula covered with a moist gauge,
have objections and needs relook. Equipment like Laser and Nerve Miter box[[2]] are expensive and are not readily available.
We the authors are describing a simple and effective way of atraumatically trimming
the lacerated nerves before repair.
The nerve trimming device that is being described in this original work is very simple
in its design which consists of a curved (70 degree) smooth forceps with a tapered
long and narrow tip made up of stainless steel. It consist of 4 cms long forceps with
a tapered smooth end of 1mm. The prongs of the forceps themselves are proximally curved
at an angle of 70 degrees to be used as a handle. This curved handle is sufficiently
long enough (4 cms) for the ease of handling [[Figure 1]]. At a sufficient distance from the tip of the forceps, there are 3 co-linear perforations
(big enough to accept 23/25 gauge needles) on both the shafts of the prongs of the
forceps allowing the surgeon to transfix the full thickness of the structure which
is to be trimmed (including both the anterior and the posterior walls). Depending
on the size of the structure to be trimmed one or two needles can be used for the
same purpose. This provides the surgeon a reasonable control over the structure to
be trimmed in all planes with a gentle ‘’ vice’’ like grip which is fully adjustable
by his nondominant hand while trimming. A gentle longitudinal traction will provide
both anterio –posterior and medio –lateral stability allowing the surgeon to transect
the nerve with the blade guided by the jig like effect and support provided by the
prongs of the frame as shown in [Figures 2]
[3]
[4]. Patent of the forceps is pending.
Figure 1: Nerve trimming device
Figure 2: Simulation of nerve assembled on the device ready for trimming
Figure 3: Intra-operative demonstration of the nerve trimmer assembly
Figure 4: Damaged nerve resected along with the trimmer
Financial support and sponsorship
Nil.
