MICROSURGICAL NEUROLYSIS - ITS ANATOMICAL AND PHYSIOLOGICAL-BASIS ANDITS CLASSIFICATION

Neurolysis is a procedure which has to be performed if the gliding app aratus of a peripheral nerve does not function, and consequently, adhe sions and fibrosis develop. The gliding tissue has to provide the abil ity for the nerve to adapt to the different position of the extremity by longitudinal passive movement. The paraneurium provides movements b etween the nerve and the surrounding tissue; the interfascicular epine urium provides the possibility of the movement within the nerve. Inter nal neurolysis is defined as surgery within the nerve if the epifascic ular epineurium is completely transected. A classification of differen t degrees of fibrosis is given with special reference to the procedure which has to be done in each case. Neurolysis is a step-wise procedur e with the aim to decompress the fascicles and which is immediately st opped if this aim is achieved. In very severe cases, if the gliding ti ssue does not regenerate, a gliding tissue flap to envelope the nerve may solve the problem. (C) 1993 Wiley-Liss, Inc.