This is an old revision of the document!
Table of Contents
Dr. Domeshek Introduction
- Undergraduate: Duke University, BSE, 2001-2005
- Medical School: Duke University School of Medicine, 2005-2010
- Resident, General Surgery: Barnes-Jewish Hospital/Washington University School of Medicine, 2010-2013
- Resident, Plastic Surgery: Barnes-Jewish Hospital/Washington University School of Medicine, 2013-2016
- Fellow, Plastic Surgery & Hand, Peripheral Nerve & Microsurgery: Barnes-Jewish Hospital/Washington University School of Medicine, 2016-2017
- Fellow, Plastic Surgery, Pediatric Plastic Surgery, Hospital for Sick Children, 2017-present
Nerve Transfers
The Wash-U Mackinnon Video Series is a MUST WATCH before doing a nerve transfer with Dr. Domeshek. She did fellowship with Mackinnon in 2016-2017.
Medial head of triceps to Axillary Nerve
Spinal Accessory to Suprascapular
Double Fascicular
Lip Laceration
She prefers 3-0 or 4-0 vicryl for the orbicularis muscle. This was a lip washout and then 4-0 or 5-0 preferred chromic for the wet part of the lip and 5-0 plain got for the dry part of the lip put a little Vaseline on that and make sure you do a very thorough wash out.
Triceps to Axillary Nerve Transfer
The patient was taken to the operating room and secured on the operating room table. Following patient and procedure confirmation, anesthesia was begun. The site was prepped and draped in standard sterile fashion. A preoperative time-out was performed confirming site, laterality, patient and procedure to be performed.
The scapular spine and border was marked. A curvilinear incision was made over the posterior arm at shoulder, posterior to the deltoid. The deltoid and teres minor interval was identified, and there was a significant amount of scarring and adhesion along the axillary nerve. The sensory branch was identified and traced to the main superior and inferior branches, and these were circumferentially dissected free of the scar and neurolysed.
Nerve stimulation demonstrated no firing of the superior or inferior branch, and we therefore proceeded with the nerve transfer.
The interval between the triceps was identified, and the radial nerve found. The medial most branch was excluded and protected with a vessel loop. Nerve stimulation demonstrated isolated triceps stimulation without hand or forearm extensor function. The branch was traced into the muscle to gather sufficient length. It was distally transected and brought superiorly.
Using the microscope, the axillary nerve was tripped of the surrounding soft tissue scarring and adhesions, and cut back to healthy appearing fascicles. An end to end coaptation between the radial branch and recipient axillary branch was performed with 9-0 nylon and the microscope. Fibrin glue was placed over the coaptation.
The deep muscular layers were then re approximated with 2-0 and 3-0 pds. The skin flaps were then closed with 3-0 and 4-0 monocryl and dermabond. A bulky dressing was applied.
He was then transferred to the stretcher and returned to supine position. The patient was awoken from anesthesia and transported to recovery in stable condition.
Tourniquet: No
Drain: No
Sutures: 9-0 nylon, 3-0 and 4.0 monocryl and dermabond
Dressing: bulky dressing