Surgery of Peripheral Nerves and Tendons
by Meyer - Pat. pend.
Prof. Dr. Viktor E. Meyer, University Hospital Zurich, Zurich, Switzerland
In reconstruction of peripheral nerves, the exact fascicular coaptation is one of several important factors, upon which we have a direct influence, at least to a certain degree.
A straight and even cut-surface of the nerve stumps greatly facilitates the exact fascicular coaptation.
The submitted holding forceps were developed to trim nerve stumps smoothly with a blade, without additional trauma by the holding device and with a minimal loss of substance. The simple design makes their application possible also in cases of difficult surgical exposure. The eccentrically placed guide slot makes a very economical trimming of the nerves possible, for example, as preparation for a direct suture.
Scanning electron microscopical comparison of stumps of the human sural nerve, cut by a toothed pair of scissors, respectively by the method applied here, have shown that the anatomical changes of the cut-surface is less evident by using a sharp blade than by using a toothed pair of scissors (V. E. Meyer and J. Smahel: The Surgical Cut-Surface of Peripheral Nerves, International Journal for Microsurgery, 2: 187, 1980). By this technique smooth and straight surface-cuts can be achieved, especially on larger nerves, which also facilitates assessment of the fascicular topography.
For trimming of small single fascicles or small groups of fascicles the application of serrated scissors is recommended.
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Clinical and laboratory experience has shown that this instrumentarium facilitates the dissection and/or the trimming of other cylindrical anatomical structures, above all, if in a saving manner a smooth surface should be achieved (Tendons, Fallopian Tubes, Vas Deferens, Vessels, etc.): It has proven its usefulness especially in hand surgery at trimming the tendon stumps. Not only extraordinarily smooth tendon surfaces can be cut, but the instrumentarium also permits the gentle handling of the stumps for suturing (Fig. 1 and Fig. 2).

Figure 1:
Scanning electron microscopical picture of a resection by above technique of a non-fixated human flexor tendon.

Figure 2:
The holding forceps is a gentle handling instrument for the tendon stumps at suturing.

Figure 3:
Resected slices of median nerve at a secondary suturing. Using the holding forceps slices as thin as 1mm can be easily cut.
Applied holding forceps, with blade in guide slot. An oscillating movement under slight pressure and constant rinsing results in a straight, smooth resection of the nerve end.
Insert blade carefully into guide slot to avoid damage to its cutting edge. Clean the guide slot under running water, with the back of the used blade. Avoid spreading and distorting the guide slot. Don't use blades, which are too thick. The S&T blade CBS-35 is recommended.

The examination of cut-surfaces of peripheral nerves and tendons has been performed in cooperation with J. Smahel, M.D., Chief of the Research Laboratory of the Surgical Clinic B, University of Zurich Medical School, Zurich, Switzerland.
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In reconstruction of peripheral nerves, the exact fascicular coaptation is one of several important factors, upon which we have a direct influence, at least to a certain degree.
A straight and even cut-surface of the nerve stumps greatly facilitates the exact fascicular coaptation.
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