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L.G.,
sharp transection with knife ??may?? be best technique (not proven) vs. cutting with scissors which makes for a more imprecise (not even) cut of the nerve. There has been talk of actual nerve sheath issues causing the problems with the nerve it envelops but again, no scientific proof of this but it does in my mind go back to an even sharp cut to transect a nerve gives the least probability of post op nerve pain. The cautery issue is that the electical power is not point specific but travels a few mm and damages the nerve, partially in some areas, more or less in others.
The analogy is that limb crush injuries that do not result in amputation have worse dysesthesias (nerve pain) than operative amputations, all comers so with that said, traumatizing a major nerve (crush, clamp, oblique cut, etc) likely leads to the neuroma formation and the increased chances for pain.
I had a guy a few yearsd ago with a traumatic amputation (I had posted pictures) that the 1st operation I did was damage control, control the bleeding, clean it and no definitive nerve work, he woke up with terrible pain and once I brought him back and took care of the nerve as I described, he has no pain.
No guarantees with this one, just alot of cases and some science to back it up....sorry.
ss
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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