Epineurial junction implants, instruments, and methods

Abstract

The conduit carrier includes a carrier housing that includes first and second contact ends and a vacuum channel extending between them. The vacuum channel is configured to connect to a vacuum source via the first contact end. An engagement mechanism is connected to the second contact end. The engagement mechanism is configured to engage with the conduit in a releasable manner during nerve repair surgery. A separator is configured to extend from the second contact end. When the engagement mechanism engages with the conduit during nerve repair surgery, the vacuum channel is connected to a vacuum port in the conduit via the second contact end so that a vacuum source can draw a vacuum into the conduit, and the separator extends into the conduit through the vacuum port, creating a predetermined regeneration gap between the first and second nerve stumps inserted into the conduit.

Description

Cross - reference to related applications

[0001] This application is a non - provisional application of U.S. Provisional Application No. 63 / 491868, entitled "EPINEURIAL COAPTATION IMPLANTS, INSTRUMENTS AND METHODS", filed on March 23, 2023, claiming the benefit of its filing date, the content of which is hereby incorporated by reference in its entirety into this specification.

Technical Field

[0002] The present invention is in the field of repair of damaged peripheral nerves.

Background Art

[0003] Nerve damage is caused by laceration, crush, rupture, or puncture. Patients suffer loss of sensory and motor abilities. The hand and wrist are the most common sites of nerve repair, but nerve repair is performed on all extremities.

[0004] A nerve is composed of a number of individual nerve cells, i.e., axons, bundled together as nerve cords, wrapped in perineurium, and this is combined with other bundled axons and blood vessels and enclosed in an outer sheath called the epineurium. The epineurium is thin, flexible, and almost translucent. When a nerve is cut, a scar is formed.

[0005] Nerve cells, i.e., axons, can elongate at a rate of 1 millimeter per day in the distal direction from the proximal stump with a growth cone. They cannot penetrate the scar, and its chemical nature inhibits axon growth. In many cases, the scar must be surgically removed.

[0006] Repair depends on the distance between the viable ends of the stumps. If there is no gap, the stumps can be directly sutured together.

[0007] Aligning and bringing the stumps together is defined as coaptation in medical terms.

[0008] In injuries with gaps less than 5 millimeters, if the stumps are brought close together, cells can connect with the distal stump, allowing for functional recovery. The use of conduits is an effective method for joining the stumps. Larger gaps are treated with absorbable scaffolds or grafts (Griffin JW. Peripheral nerve repair and reconstruction. J Bone Joint Surg Am. 2013 Dec 4;95(23):2144-51).

[0009] The effective repair of damaged nerves has long been a cumbersome problem, largely confined to the domain of plastic surgeons or hand surgeons skilled in microsurgery. Precisely anastomosing nerve ends to form a stable and secure connection without causing overlap of nerve bundles remains a challenging surgical problem, even for skilled and experienced surgeons.

[0010] The handling of conduits and grafts is typically done manually. Joining is performed by manually positioning a thin suture inside the scaffold towards the stump, then pulling the end of the suture to move the stump into the scaffold tube. Nerve attachment is done by passing an 8-0 suture through the thin and delicate epineurial tissue. Suture breakage is not uncommon, requiring time-consuming repetitions of these steps. When passing a needle through the conduit, the needle may break due to its small size.

[0011] Connecting nerves to a duct with sutures typically means the duct must be made larger, leaving a large radial gap that makes it difficult to control the advancement of the axon.

[0012] Measuring the stump size to select the appropriate conduit size is typically done with a basic straight ruler. The ruler is often 1 cm wide, partly due to the size measurement information being adjacent to the length markings, and is relatively large when the repair is being done on the hand of a small female patient. The ruler relies on the surgeon to align the ruler by visually positioning zero on one side of the nerve and visually aligning it with the other side of the nerve and the markings on the scale. There is a second possibility of parallax error and inaccurate measurement.

[0013] The pursuit of a reliable, simple, and effective method for repairing these nerve endings led to the development of this device. [Overview of the project] [Problems that the invention aims to solve]

[0014] The present invention provides a vacuum decompression device that allows the joining of both ends of a severed nerve without crushing the conduit, is easy to release, and requires only minimal incision, along with related instruments that facilitate the simplification of nerve end preparation, rapid and accurate nerve sizing, and ease of use of suturing tools. The disclosed invention greatly simplifies the repair process, making high-quality and effective nerve repair more efficient and more ideal for subsequent nerve regrowth. Furthermore, the device allows for significantly improved control of nerve terminals during the anastomosis process, allowing for better control of the end gap and gentler handling of tissue. These advances make high-quality nerve repair smoother and faster for surgeons, and furthermore, make nerve repair available to surgeons without requiring extensive microsurgical training and experience. [Means for solving the problem]

[0015] A conduit according to one or more aspects of the present disclosure includes a conduit body comprising first and second oppositely oriented open ends and a hollow conduit interior extending between them. The conduit interior is configured to receive a first nerve stump through the first open end and a second nerve stump through the second open end during a patient's nerve repair surgery. A vacuum port extends through the outer wall of the conduit body. The vacuum port is connected to a vacuum source associated with the conduit carrier and is configured to draw a vacuum into the conduit interior when the nerve stump is inserted into the first and second open ends. At least one radial support structure is positioned on the outer wall of the conduit body. The at least one radial support structure is configured to structurally support the conduit body when a vacuum is applied.

[0016] A conduit carrier according to one or more aspects of the present disclosure includes a carrier housing comprising first and second contact ends and a vacuum channel extending between them. The vacuum channel is configured to be connected to a vacuum source via the first contact end. An engagement mechanism is connected to the second contact end. The engagement mechanism is configured to be releasably engaged with the conduit during a patient's nerve repair surgery. A separator is configured to extend from the second contact end. When the engagement mechanism engages with the conduit during nerve repair surgery, the vacuum channel is connected to a vacuum port in the conduit via the second contact end so that a vacuum source can draw a vacuum into the conduit, and the separator extends into the conduit through the vacuum port, creating a predetermined regeneration gap between the first and second nerve stumps inserted into the conduit.

[0017] A nerve sizing instrument according to one or more embodiments of the present disclosure for measuring the size of a nerve stump during nerve repair surgery in a patient includes a nerve sizing instrument comprising a plurality of U-shaped recesses. Each of the plurality of U-shaped recesses is configured to receive a nerve stump having a diameter up to a predetermined maximum nerve stump diameter that is different from any of the other maximum nerve stump diameters relating to any of the other recesses.

[0018] A scar trimmer according to one or more embodiments of the present disclosure for resecting nerve stumps during nerve repair surgery in a patient includes a longitudinally extending housing assembly having an anterior and a posterior end. An anterior boss is located at the anterior end. A stump cutting cavity is located within the anterior boss. The stump cutting cavity is configured to receive a nerve stump, which extends through the stump cutting cavity. An internal slider is located inside the housing assembly. The internal slider is movable between an anterior and posterior position relative to the housing assembly. A blade is slidably captured by the internal slider. As the nerve stump extends through the stump cutting cavity and the internal slider is moved between the posterior and anterior positions, the blade slides through the stump cutting cavity and resects the scarred end of the nerve stump.

[0019] A method for performing a patient nerve repair surgery according to one or more aspects of the present disclosure includes determining the diameter of a first nerve stump by fitting the first nerve stump into a U-shaped recess of a nerve sizing instrument. Based on the determined diameter of the first nerve stump, a conduit and a conduit carrier are selected. The selected conduit is releasably engaged with the selected conduit carrier. A first separator of the conduit carrier extends into the vacuum port of the conduit. The vacuum channel of the conduit carrier is connected to the vacuum port of the conduit. Vacuum is drawn into the conduit through the vacuum channel. While drawing vacuum, the first and second nerve stumps are inserted into the first and second open ends of the conduit, respectively. The first separator is utilized to provide a predetermined regeneration gap between the first and second nerve stumps.

[0020] It should be understood that all combinations of the aforementioned and additional ideas described below (as long as such ideas are not contradictory) are considered to be part of the subject matter of the invention disclosed herein and may be used to achieve the benefits and advantages described herein.

[0021] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with the detailed description of the disclosure, serve to explain the principles of the disclosure. It is to be emphasized that various features are not drawn to scale in accordance with standard industry practice. In fact, the dimensions of the various features may be arbitrarily increased or reduced for clarity of explanation. The drawings are provided only to illustrate preferred embodiments and are not to be construed as limiting the disclosure.

Brief Description of the Drawings

[0022] [Figure 1] Side view of a prior art conduit. [Figure 2] Cross-sectional side view of a prior art conduit carrier and another prior art conduit attached thereto. [Figure 3] Cross-sectional top view of the prior art conduit and conduit carrier of FIG. 2. [Figure 4] Cross-sectional view of the prior art conduit carrier of FIG. 3 taken along line 4-4 of FIG. 3. [Figure 5] Perspective view of a conduit according to one aspect of the disclosure, having tabs and with the vacuum port flap open. [Figure 6] Perspective view of a conduit according to one aspect of the disclosure, having tabs and with the vacuum port flap closed. [Figure 7] Side view of a conduit according to one aspect of the disclosure, having tabs and a simple vacuum port. [Figure 8] End view of a conduit according to one aspect of the disclosure, having a fixed tab. [Figure 9] Perspective view of a conduit according to one aspect of the disclosure, having a movable tab and with the vacuum port flap open. [Figure 10] Perspective view of a conduit according to one aspect of the disclosure, having a movable tab and with the vacuum port flap closed. [Figure 11] Perspective view of a conduit according to one aspect of the disclosure, having a movable tab and a simple vacuum port. [Figure 12] This is a perspective view of a conduit according to one aspect of the present disclosure, having a rounded end and an unfolding tab. [Figure 13] This is a perspective view of a less rigid conduit according to one aspect of the present disclosure, having a rounded end and an unfolding tab. [Figure 14] This is a perspective view of a less rigid conduit according to one aspect of the present disclosure, having a rounded end and a partially extended deployment tab. [Figure 15] A perspective view of a less rigid conduit according to one aspect of the present disclosure, having an unfolded end and a fully extended unfolding tab. [Figure 16] This is a perspective view of a less rigid conduit according to one aspect of the present disclosure, with the deployment tab removed. [Figure 17] This is a perspective view of a size measuring instrument according to one aspect of the present disclosure. [Figure 18] This is a side view of a size measuring instrument according to one aspect of the present disclosure. [Figure 19] This is a bottom view of a size measuring instrument according to one aspect of the present disclosure. [Figure 20] This is a perspective view of a size measuring instrument having nerve stumps according to one aspect of the present disclosure. [Figure 21] This is a side view of a size measuring instrument having nerve stumps according to one aspect of the present disclosure. [Figure 22] This is an enlarged view of the cross-section within the size measuring groove according to one aspect of this disclosure. [Figure 23] This is a perspective view of a scar trimmer according to one aspect of the present disclosure. [Figure 24] This is a side view of a scar trimmer according to one aspect of the present disclosure, with the blade retracted. [Figure 25] This is a side view of a scar trimmer according to one aspect of the present disclosure, with the blade in the forward position. [Figure 26] This is a side view of a scar trimmer having a large opening according to one aspect of the present disclosure. [Figure 27] This is a top view of a scar trimmer according to one aspect of the present disclosure. [Figure 28]This is a cross-sectional view of a scar trimmer having a large opening and an angled blade according to one aspect of the present disclosure. [Figure 29] This is an exploded side view of a scar trimmer according to one aspect of the present disclosure. [Figure 30] This is a side view of a scar trimmer having an open slot according to one aspect of the present disclosure, with the blade retracted. [Figure 31] This is a perspective view of a scar trimmer and a scarred margin according to one aspect of the present disclosure. [Figure 32] This is a perspective view of a nerve having a cleanly cut end according to one aspect of the present disclosure. [Figure 33] This is a perspective view of a conduit carrier according to one aspect of this disclosure. [Figure 34] This is a side view of a conduit carrier in a closed jaw position according to one aspect of the present disclosure. [Figure 35] This is a side view of a conduit carrier with its jaws open, according to one aspect of the present disclosure. [Figure 36] This is a side view of a conduit carrier in which the jaw portion is open and the conduits are separated, according to one aspect of the present disclosure. [Figure 37] This is a decomposed perspective view of a conduit carrier according to one aspect of the present disclosure. [Figure 38] This is a side view of a conduit carrier in a closed jaw position according to one aspect of the present disclosure. [Figure 39] This is a top view of a conduit carrier in a closed jaw state according to one aspect of the present disclosure. [Figure 40] This is a cross-sectional view of a conduit carrier with the jaw portion closed, according to one aspect of the present disclosure. [Figure 41] This is an enlarged side view of a conduit carrier according to one aspect of the present disclosure, showing a separator. [Figure 42] This is a side view of a conduit carrier with its jaws open, according to one aspect of the present disclosure. [Figure 43] This is a top view of a conduit carrier with the jaw portion open, according to one aspect of the present disclosure. [Figure 44] This is a cross-sectional view of a conduit carrier with its jaws open, according to one aspect of the present disclosure. [Figure 45] This is a cross-sectional view of a conduit carrier according to one aspect of the present disclosure. [Figure 46] This is a perspective view of a central housing for a conduit carrier for a movable separator according to one aspect of the present disclosure. [Figure 47] This is a perspective view of a conduit carrier central housing having a fixed separator according to one aspect of the present disclosure. [Figure 48] This is a side view of a conduit carrier engaged with two nerve stumps according to one aspect of the present disclosure. [Figure 49] This is a top view of a conduit carrier engaged with two nerve stumps according to one aspect of the present disclosure. [Figure 50] This is a cross-sectional view of a conduit carrier engaged with two nerve stumps according to one aspect of the present disclosure. [Figure 51] This is a cross-sectional view of the closed jaw portion of a carrier sandwiching a conduit tab according to one aspect of the present disclosure. [Figure 52] This is a side view of the jaw according to one aspect of the present disclosure. [Figure 53] This is a bottom view of the jaw portion according to one aspect of the present disclosure. [Figure 54] This is a cross-sectional view of the jaw region according to one aspect of this disclosure. [Figure 55] This is a perspective view of the jaw region according to one aspect of this disclosure. [Figure 56] This is a perspective view of a completed direct restoration according to one aspect of this disclosure. [Figure 57] This is a side view of a completed direct restoration according to one aspect of the present disclosure. [Figure 58] This is a cross-sectional view of a completed direct restoration according to one aspect of this disclosure. [Figure 59] This is a perspective view of a stepped diameter conduit according to one aspect of the present disclosure. [Figure 60] This is a side view of a stepped diameter conduit according to one aspect of the present disclosure. [Figure 61] This is a cross-sectional view of a stepped diameter conduit according to one aspect of the present disclosure. [Figure 62] This is a top view of a carrier for a rounded end conduit according to one aspect of the present disclosure. [Figure 63] This is a side view of a carrier for a rounded end conduit according to one aspect of the present disclosure. [Figure 64] This is a cross-sectional view of a carrier for a rounded end conduit according to one aspect of the present disclosure. [Figure 65] This is a cross-sectional view of a carrier for a rounded end conduit according to one aspect of the present disclosure. [Figure 66] This is a perspective view of short-gap repair according to one aspect of this disclosure. [Figure 67] This is a side view of a short gap repair according to one aspect of this disclosure. [Figure 68] This is a cross-sectional view of a short gap repair according to one aspect of the present disclosure. [Figure 69] This is a perspective view of a scar trimmer pull-cutting blade according to one aspect of the present disclosure. [Figure 70] This is a perspective view of a lever carrier housing having a separator according to one aspect of the present disclosure. [Figure 71] This is a side view of a lever carrier having a separator according to one aspect of the present disclosure. [Figure 72] This is a detailed diagram of a lever carrier having a separator according to one aspect of the present disclosure. [Figure 73] This is a perspective view of a completed long defect repair according to one aspect of this disclosure. [Figure 74] This is a side view of a completed long defect repair according to one aspect of the present disclosure. [Figure 75] This is a cross-sectional view of a completed long defect repair according to one aspect of the present disclosure. [Figure 76] This is a side view of a carrier support stand according to one aspect of the present disclosure. [Figure 77] This is a perspective view of a carrier support stand according to one aspect of the present disclosure. [Figure 78] This is a side view of a spiral conduit according to one aspect of the present disclosure. [Figure 79] This is a perspective view of a spiral conduit according to one aspect of the present disclosure. [Figure 80] This is a perspective view of a lap conduit having end tabs according to one aspect of the present disclosure. [Figure 81]This is a side view of a lever-operated carrier according to one aspect of the present disclosure. [Figure 82] This is a perspective view of a lever-operated carrier according to one aspect of the present disclosure. [Figure 83] This is an exploded perspective view of a lever operating carrier according to one aspect of the present disclosure. [Figure 84] This is a top view of a lever operating carrier according to one embodiment of the present disclosure in the released position. [Figure 85] This is a cross-sectional view of a lever operating carrier according to one embodiment of the present disclosure in the released position. [Figure 86] This is a side view of a conduit for a lever-operated carrier according to one aspect of the present disclosure. [Figure 87] This is an end view of a conduit for a lever-operated carrier according to one aspect of the present disclosure. [Figure 88] This is a perspective view of a conduit for a lever-operated carrier according to one aspect of the present disclosure. [Figure 89] This is a side view of a simplified conduit holder according to one aspect of the present disclosure. [Figure 90] This is a side view of a simplified conduit holder and conduit according to one aspect of the present disclosure. [Figure 91] This is a cross-sectional view of a simple conduit holder and conduit according to one aspect of the present disclosure, along line 91-91 in Figure 90. [Figure 92] This is a detailed diagram of a simplified conduit holder and conduit according to one aspect of the present disclosure. [Figure 93] This is a perspective view of a multi-port conduit according to one aspect of this disclosure. [Figure 94] This is a perspective view of a conduit having a connecting tab according to one aspect of the present disclosure. [Figure 95] This is a perspective view of a conduit having a double vacuum port according to one aspect of the present disclosure. [Figure 96] This is a perspective view of a conduit having a slit according to one aspect of the present disclosure. [Figure 97] This is a perspective view of a conduit having a dovetail tab in an open position according to one aspect of the present disclosure. [Figure 98]This is a perspective view of a conduit having a dovetail tab in a closed position according to one aspect of the present disclosure. [Figure 99] This is an end view of a conduit having a dovetail tab in an open position according to one aspect of the present disclosure. [Figure 100] This is an end view of a conduit having a stepped tab in an open position according to one aspect of the present disclosure. [Figure 101A] This is a flowchart of a method according to several aspects of the present disclosure for performing nerve repair surgery. [Figure 101B] This is a continuation of the flowchart of the method shown in Figure 101A according to several aspects of this disclosure. [Explanation of symbols]

[0023] 100 Conduit 110 Vacuum Ports 120 Vacuum Port Flap 130 Retaining tab 135 Central holding tab 140 Conduit wall 145 Clamping plane 150 Open end for nerve stump 155 Conduit center line 160 Closed flap 170 Conduit with bendable tab 180 Retaining tabs folded outwards 190 Foldable retaining tab recess 195 Neutral position retaining flap 200 Conduit with rounded edges 220 Rounded ends 230 Surgical end inlet area 240 Expand tabs 250 Recessed tab 260 Opening for elastic adjustment of conduit 270 Expanded tabs (partially extended) 280 Fully expanded tabs 290 Deployed conduit end 300 deployed conduits 350 Minimally Invasive Nerve Size Measurement Devices 360 Arm 370 Hub 380 U-shaped recess 390 Reference plane 400 Size Information 410 Nerve stump 450 Scar Trimmer 455 Trimmer Housing 460 Notch Trimmer Housing 465 Operation button limiting recess 470 Activation Button 480 Stump Cutting Cavity 490 Front Boss 500 blades 510 Angled Blade 520 oval-shaped cutting cavity 530 Return spring 535 Spring trapping loop 540 Blade Capture Boss 550 Fasteners 560 Internal Slider 570 nerve bundles 580 Scar 590 Stump Cutting Access Slots 595 V-shaped recess 600 Conduit Carrier 610 Vacuum connection cylinder 620 Silicone Sleeves 630 Conduit carrier central housing 640 Release button 650 vacuum control ports 660 Conduit-capturing jaw 670 Separator and jaw spring 680 Pipe size indication 690 Jaw Hinge Boss 700 retaining pins 710 Separator Loop 720 Cantilever spring 730 Release Button Spring Boss 740 Spring wire bending section 750 Detent for Closed Position 755 Stabilizing interlock recess 760 Detent for open position 765 Partial cylindrical boss 770 Stabilizing interlock boss 775 Internal vacuum channel 780 Spring Loop Capture Notch 790 Spring clearance recess 800 Fixed Separator 810 Conduit contact surface 820 Tab clamping surface 825 Tab Recess 830 Space inside the separator 840 Conduit carriers, conduits, and nerve stumps 850 Low-voltage area 860 Vacuum channel in fixed separator 865 Jaw contact surface 870 Tab capture recess 880 Hinge recess 890 Suture thread 895 Regeneration Gap 900 stepped diameter conduit 905 Radial gap 910 Central part of the conduit 920 Reduced diameter end 930 Carrier for rounded end conduits 940 Reverse Separator 950 Floating jaw 960 Flexible retainer 970 Expand tab hold boss 980 Vacuum Channel 990 Partial cylindrical surface 1000 Large Gap Repair Structures 1010 Large gap conduit 1020 Pull Cutting Blade 1030 Reverse cutting edge 1200 completed long defect repairs 1220 Allogeneic nerve graft 1300 Carrier Stand 1310 Carrier tube recess 1320 Carrier stand base 1330 Carrier tube feed channel 1400 Wrapped conduit 1410 Spiral Wall 1420 Continuous support tab 1425 Inner spiral end 1430 Vacuum Port 1450 Lap conduit with end tabs 1460 Linking Tabs 1500 Lever-operated carrier 1510 Lever-operated carrier housing 1520 Lever jaw 1530 Lever spring 1540 Conduit with two end tabs 1550 180-degree tab 1560 Port Support Tab 1565 Helical end tab 1570 Jaw pivot boss 1580 Jaw pivot hinge recess 1585 Spring Hook 1590 Vacuum valve 1650 Simple conduit holder 1655 Simple conduit holder handle 1660 vacuum opening 1670 Simple separator 1680 Extended separator area 1690 Internal Vacuum Channel 1695 Conduit with circular vacuum port 1700 Lever Carrier and Separator 1710 Lever-operated carrier housing and separator 1720 Contact surface 1800 Multi-port conduit 1810 Conduit with connecting tabs 1820 Mutually linked tabs 1830 Radial tab section 1840 Connecting part 1850 Retaining recess 1860 Retaining spring 1870 Thread Loop 1875 Conduit with small ports 1880 Small Vacuum Port 1885 Conduit with slits 1890 Slit for separator 1900 Vessels with dovetail-shaped tabs 1910 Dovetail tab 1920 Dovetail tenon-shaped tab recess 1930 Dovetail-shaped tab base 1940 Dovetail tab end 1950 Closed dovetail tab 1960 Conduit with stepped tab 1970 Stepped Tab Method Steps 2000-2028 [Modes for carrying out the invention]

[0024] Herein, specific examples are described to provide an overall understanding of the structure, function, manufacture, and use principles of the methods, systems, and apparatus disclosed herein. One or more examples are shown in the accompanying drawings. Those skilled in the art will understand that the methods, systems, and apparatus described herein and shown in the accompanying drawings are non-limiting examples, and the scope of this disclosure is defined solely by the claims. Features illustrated or described in connection with one example may be combined with features of other examples. Such modifications and variations are intended to be within the scope of this disclosure.

[0025] The terms “significantly,” “substantially,” “approximately,” “about,” “relatively,” or other similar terms, which may be used throughout this disclosure including the claims, are used to describe and consider small deviations from a standard or parameter resulting from variability in processing, etc. Such small deviations include zero deviation from the standard or parameter. For example, they may refer to ±10% or less, e.g., ±5% or less, e.g., ±2% or less, e.g., ±1% or less, e.g., ±0.5% or less, e.g., ±0.2% or less, e.g., ±0.1% or less, e.g., ±0.05% or less.

[0026] Figure 5 is a perspective view of a conduit with tabs fixed and vacuum port flaps open. The conduit 100 is a generally cylindrical hollow tube 140. It may be made of silicone, polymer, or absorbent fiber, and may be solid or trabecular. The manufacturing method may be molding. The conduit has a side opening 110, i.e., a vacuum port, located approximately in the middle of the length of the tube. The material adjacent to the port may be folded back to create one or more vacuum flaps, which serve to prevent growing axons from emerging from the tube after implantation. A series of retaining tabs 130 are present near the ends of the tube to maintain the shape of the tube during vacuum bonding. These are essential when the tube is made from a thin, flexible material. The width of the tabs may vary from 0.2 to 3 millimeters, the length of the tabs parallel to the centerline may vary from 1 to 20 millimeters, and the height of the tabs may vary from 0.5 to 5 millimeters. The preferred number of tabs adjacent to each end is three, but this can vary from two to six.

[0027] The flap adjacent to the vacuum port is held open by a solid separator, as shown in a later figure. The shape of the opening 150 is approximately circular, matching the cross-sectional shape of the nerve stump. The centerline 155 of the conduit is the geometric axis of the conduit wall 140.

[0028] Figure 6 shows the same molded conduit as in Figure 5, but the vacuum port flap is in the closed position 160.

[0029] Figure 7 shows a side view of the conduit 100. Another embodiment of the vacuum port area without a flap is shown. The vacuum port 110 is 1 to 5 millimeters high and 0.1 to 4 millimeters wide. The conduit wall surrounds most of the advancing axon, and relatively small openings such as the vacuum port 110 do not significantly impair this advantage of the conduit.

[0030] Figure 8 is an end view of the conduit 100. The three retaining tabs 130 are positioned at approximately equal intervals. The number of tabs may be between 2 and 6. The positions of the three tabs maintain the shape of the nerve introduction opening 150 both when a vacuum is applied to the instrument and when it is not. The clamp plane 145 passes through the central retaining tab 135 and the conduit centerline 155.

[0031] Figure 9 is a perspective view of a conduit 170 with a bent tab, and the vacuum port flap is open. The conduit 100 is a generally cylindrical hollow tube 140. It may be made of silicone, polymer, or absorbent fiber, and may be solid or trabecular. The manufacturing method may be molding, electrodeposition, laser, or die cutting. The conduit has a lateral opening 110, i.e., a vacuum port, located approximately in the middle of the conduit's length. The material adjacent to the port may be folded back to create a vacuum flap that serves to prevent the growing axon from emerging from the conduit after implantation. To maintain the shape of the conduit during vacuum bonding, a series of projections, i.e., bent tabs 180, are present near the end of the conduit, which are bent away from the conduit wall, leaving an opening 190. These openings are away from the axon regrowth cavity. Their relatively small size does not interfere with vacuum bonding of the nerve stump by the instrument. The folded tab 180 is preferred when the conduit is made from a material that is difficult to injection mold. The shape of the opening 150 is approximately circular, matching the cross-sectional shape of the nerve stump. The width of the folded tab is 0.2 to 3 millimeters, and the length parallel to the center line is 1 to 20 millimeters. The preferred number of tabs is three, but it can vary from two to six.

[0032] Figure 10 is a perspective view of a conduit 170 having radial support tabs 195 in a relaxed or closed position. The vacuum flap 160 is also in the closed position.

[0033] Figure 11 is a perspective view of a conduit 170 having an expanded bendable tab 180 and a simple opening vacuum port 110.

[0034] Figure 12 is a perspective view of a conduit 200 having a rounded end, the rounded end 220 having a nerve inlet region 230 that provides radial support and maintains its shape. The conduit 200 having a rounded end has a vacuum port 110. It has two deployment tabs 240 for deploying the rounded end 220. The deployment tabs 240 have openings 250 for maintaining their position during storage and when using the instrument. A deployment tab 240 is present at each end of the conduit.

[0035] Figure 13 is a perspective view of a conduit having rounded ends 220. The wall of the conduit has openings 260 near each end. The openings 260 are typically 4 to 12 in number and are radially spaced apart. The openings 260 allow the size and elasticity of the conduit to be adjusted in terms of ease of deployment and contact force with nerves. A deployment tab 240 is used to deploy the rounded ends 220 and has a retaining hole 250.

[0036] Figure 14 is a perspective view of conduit 200 having a rounded end, with the unfolding tab 270 partially extended.

[0037] Figure 15 is a perspective view of conduit 200 with a rounded end, where the unfolding tab 280 is fully extended and the unfolded end 290 of the conduit is in its final position.

[0038] Figure 16 is a perspective view of the end-rounded conduit 300 with both unfolding tabs 280 removed.

[0039] Figure 17 is a perspective view of the minimally invasive nerve sizing device 350. The minimally invasive nerve sizing device 350 has a number of arms 360 extending from a hub 370. The arms 360 support narrow U-shaped recesses 380. Each arm has a separate sizing information 400 located in the central region.

[0040] Figure 18 is a side view of the minimally invasive nerve size measuring instrument 350. The U-shaped recess 380 and the adjacent reference plane 390 can be seen. Each arm has a U-shaped recess 380 of different dimensions, with an increment of preferably 1 millimeter.

[0041] Figure 19 is a bottom view of the minimally invasive nerve size measuring instrument 350. The hub 370 allows rotation between the fingertips to position the appropriate arm 360 in place. The number of arms varies from three to eight.

[0042] Figure 20 is a perspective view of the minimally invasive nerve size measuring device 350 with the nerve stump 410 engaged with the U-shaped recess 380.

[0043] Figure 21 is a side view of the minimally invasive nerve size measuring device 350 with the nerve stump 410 engaged with the U-shaped recess 380.

[0044] Figure 22 is a detailed side view of the minimally invasive nerve size measuring device 350 with the nerve stump 410 engaged in the U-shaped recess 380. The tangential relationship between the reference plane 390 and the surface of the nerve stump 410 serves as an indicator for selecting an appropriate recess size.

[0045] Figure 23 is a perspective view of the scar trimmer 450. The trimmer has a trimmer housing 455 and a notched trimmer housing 460, an actuation button 470 and a forward narrow boss 490 having a nerve stump cutting cavity 480.

[0046] Figure 24 is a side view of the scar trimmer 450 with the activation button 470 in the idle state. The stump cutting cavity 480 is open and unobstructed.

[0047] Figure 25 is a side view of the scar trimmer 450 with the activation button 470 in the forward position. The stump cutting cavity 480 is closed, but the blade 500 can be seen.

[0048] Figure 26 is a top view of a scar trimmer 450 having a trimmer housing 455 and a notched trimmer housing 460, and an operating button 470.

[0049] Figure 27 is a side view of the scar trimmer 450 with the activation button 470 in the rest position. The stump cutting cavity 520 is oval-shaped.

[0050] Figure 28 is a cross-sectional view of the scar trimmer 450. The actuation button 470 has a spring-retaining loop 535, a blade-retaining boss 540, and a cutting blade having an oblique edge 510. A return spring 530 is located between the spring-retaining loop 535 of the actuation button and the surface of the trimmer housing 455.

[0051] Figure 29 is an exploded view of the scar trimmer 450. The trimmer housing 455 and the notched trimmer housing 460 capture an internal slider 560 integrated with the actuation button 470. The internal slider has a spring capture loop 535 for capturing a return spring 530. The blade 500 fits into the blade capture boss 540. An actuation button limiting recess 465 restricts the movement of the actuation button 470, the internal slider 560, and the blade 500. Fasteners 550 are used to hold the trimmer housing 455 and the notched trimmer housing 460 and other components in place.

[0052] Figure 30 is a side view of a scar trimmer having an open stump cutting recess 590. The V-shaped recess 595 of the stump cutting access slot 590 is used for smaller nerves.

[0053] Figure 31 is a perspective view of the scar trimmer 450 with the nerve stump 410 positioned at the cutting site. The scar 580 at the nerve stump is visible.

[0054] Figure 32 is a perspective view of the nerve stump 410 after scar excision, where the regrowing nerve bundle 570 is exposed.

[0055] Figure 33 is a perspective view of the conduit carrier 600. The conduit carrier central housing 630 is the main housing. The vacuum connection cylinder 610 is fitted into the conduit carrier central housing 630. A silicone sleeve 620 is present covering the vacuum connection cylinder 610. A vacuum control port 650 penetrates one side of the conduit carrier central housing 630. A conduit size indicator 680 is present on the instrument. A release button 640 is on the other side. A pair of jaws 660 are present for holding the conduit 170 with a bendable tab.

[0056] Figure 34 is a side view of the conduit carrier 600 with the jaw portion 660 in the closed position. The release button 640 is located close to the jaw portion 660. The conduit 170 with the bend tab is completely enclosed by the conduit carrier central housing 630 and the jaw portion 660. The separator and jaw spring 670 traverse the interior of the conduit 170 with the bend tab.

[0057] Figure 35 is a side view of the conduit carrier 600 in a state where the jaws 660 are open and ready to release the conduit 170 having a bend tab. Both jaws 660 are rotated away from the conduit 170 having a bend tab. The release button 640 is moved away from the conduit 170 having a bend tab.

[0058] Figure 36 is a side view of the conduit carrier 600 with the jaw portion 660 open and the conduit carrier 600 retracted from the conduit 170 having a bent tab.

[0059] Figure 37 is an exploded view of the conduit carrier 600. The separator and jaw spring 670 enter the conduit carrier central housing 630 and exit into the jaw 660. The conduit 170 with a bendable tab is located between the jaws 660. The release button 640 is inserted into the conduit carrier central housing 630 and works in conjunction with the separator and jaw spring 670. The vacuum connection cylinder 610 and silicone sleeve 620 are loaded into the conduit carrier central housing 630 and held in place by retaining pins 700.

[0060] Figure 38 is a side view of the conduit carrier 600 with the jaw portion 660 in the closed position. The jaw portion hinge boss 690 is fitted into the jaw portion 660.

[0061] Figure 39 is a top view of the conduit carrier 600 with the jaw portion 660 in the closed position. The separator and jaw spring 670 can be seen in the center of the jaw portion 660. The conduit 170 with a bent tab extends past the jaw portions 660 on both sides.

[0062] Figure 40 is a cross-sectional view of the conduit carrier 600 with the jaws 660 in the closed position. The vacuum connection cylinder 610 is held in the conduit carrier central housing 630 by retaining pins 700. The separator and jaw springs 670 each have spring wire bends 740 at their free ends. In the closed position, the spring wire bends 740 abut within the closed position detents 750 of each jaw 660. The separator and jaw springs 670 pass through the release button spring boss 730. The jaws 660 have an interlock mechanism 770 at their mating surfaces. The conduit 170, which has a bent tab, is bounded by the conduit carrier central housing 630 and the jaws 660.

[0063] Figure 41 is an enlarged side view of the conduit carrier 600, showing that the separator and the portion of the separator loop 710 of the jaw spring 670 are located within the conduit 170, which has a bent tab. The separator internal space 830 is located inside the separator loop 710.

[0064] Figure 42 is a side view of the conduit carrier 600 with the jaws 660 in the open position. The release button 640 is in the retracted position. The conduit 170 with the folding tab is exposed. The jaw hinge bosses 690 that cause rotation can be seen on each jaw 660.

[0065] Figure 43 is a top view of the conduit carrier 600 in the open position of the jaw portion 660.

[0066] Figure 44 is a cross-sectional view of the conduit carrier 600 with the jaw portion 660 in the open position. The release button spring boss 730 is moved to a retracted position that contacts the vacuum connection cylinder 610. The separator and jaw spring 670, which are in contact with the release button spring boss 730, are moved to a retracted position. The spring wire bend 740 is inside the detent 760 for the open position. The separator loop 710 is outside the conduit 170 with the bend tab. The conduit 170 with the bend tab and its bend tab 180 are not held by the jaw portion 660. The stabilizing interlock boss 770 does not prevent the conduit 170 with the bend tab from moving out.

[0067] Figure 45 is a cross-sectional view of the conduit carrier 600. The conduit carrier central housing 630 has spring clearance recesses 790 on both sides through which the cantilever spring 720 passes. An internal vacuum channel 775 is for the vacuum passing through the body of the conduit carrier central housing 630. The internal vacuum channel 775 has a pair of spring loop capture notches 780 for holding the separator loop 710 with one degree of freedom.

[0068] Figure 46 is a perspective view of the conduit carrier central housing 630 for a movable separator. The vacuum control port 650 and conduit size indicator 680 are located on one surface of the conduit carrier central housing 630. Two spring clearance recesses 790 are present. Four jaw hinge bosses 690 are present, each having a conduit contact surface 810 and two adjacent tab clamping surfaces 820. The internal vacuum channel 775 has a pair of spring loop capture notches 780. Each tab clamping surface 820 has two tab capture recesses 825.

[0069] Figure 47 is a perspective view of a conduit carrier central housing 630 having a fixed separator 800. A vacuum control port 650 and a conduit size indicator 680 are located on one surface of the conduit carrier central housing 630. Two spring clearance recesses 790 are present. Four jaw hinge bosses 690 are present, having a conduit contact surface 810 and two adjacent tab clamping surfaces 820. An internal vacuum channel 775 is located in the center of the conduit carrier central housing 630. Adjacent to the conduit contact surface 810 is a fixed separator 800 having a separator vacuum channel 860.

[0070] Figure 48 is a side view of a conduit carrier 840 engaged with two nerve stumps, and the conduit carrier 600 has two nerve stumps 410.

[0071] Figure 49 is a bottom view of the conduit carrier 840 engaged with two nerve stumps, and the conduit carrier 600 has two nerve stumps 410.

[0072] Figure 50 is a cross-sectional view of a conduit carrier 840 having two nerves. The left nerve stump 410 is fully seated within the conduit 170, which has a bent tab, and is in contact with the separator loop 710. The right nerve stump 410 is partially reduced, and a low-pressure region 850 exists between the nerve 410 and the separator loop 710. A separator space 830 exists in the center of the separator loop 710.

[0073] Figure 51 is a cross-sectional view of the jaw portion 660 that holds the conduit 170 having a bendable tab. The retaining tab 130 is held in place at three points: one point between the jaw portions 660 and two points between the conduit carrier central housing 630 within the tab capture recess 870 and the jaw portions 660. The nerve stump 410 is located inside the conduit 170 having the bendable tab.

[0074] Figure 52 is a side view of the jaw portion 660. Both jaw contact surfaces 865 are shown. The partial cylindrical boss 765 can be seen in its contour.

[0075] Figure 53 is a bottom view of the jaw portion 660. Several tab-catching recesses 870 are present on each of the jaw contact surfaces 865. The jaw contact surfaces 865 have stabilizing interlock bosses 770 and stabilizing interlock recesses 755. The features of the stabilizing interlock recesses 755 are optional.

[0076] Figure 54 is a cross-sectional view of the jaw portion 660. Two recesses are present, namely a detent 750 for the closed position and a detent 760 for the open position. The stabilizing interlock boss 770 and the stabilizing interlock recess 755 are shown by their contours.

[0077] Figure 55 is a perspective view of the jaw portion 660. The recesses on both sides are hinge recesses 880. On each jaw contact surface 865, tab-catching recesses 870 are present at both ends of the partial cylindrical boss 765. The jaw contact surface 865 has a stabilizing interlock boss 770 and a stabilizing interlock recess 755.

[0078] Figure 56 is a perspective view of a conduit 170 having a bendable tab and having nerve stumps 410. Sutures 890 are present for connecting the conduit 170 with the bendable tab to each nerve stump 410.

[0079] Figure 57 is a side view of a conduit 170 with a bendable tab, which has two nerve stumps 410. The closed flap 160 and the neutral-holding flap 195 are flattened to the cylindrical outer surface of the conduit 170 with the bendable tab. Voluntary sutures 890 are shown spaced around the end of the conduit 170 with the bendable tab.

[0080] Figure 58 is a cross-sectional view of a conduit 170 having a folded tab and having two nerve ends 410. The space between the nerve ends 410 is the regeneration gap 895. A radial gap 905 is shown adjacent to each nerve end 410.

[0081] Figure 59 is a perspective view of a stepped diameter conduit 900. The central segment of the conduit 910 is sandwiched by the reduced diameter end 920. The vacuum port 110 is generally located in the center of the central portion of the conduit 910. A series of openings 260 for elastic adjustment of the conduit may be present in the reduced diameter end 920. The stepped diameter conduit 900 can be manufactured without the elastic adjustment 260 for the conduit.

[0082] Figure 60 is a side view of a stepped diameter conduit 900. The central portion of the conduit 910 is sandwiched by the reduced diameter end 920. The vacuum port 110 is generally located in the center of the central portion of the conduit 910. A series of openings 260 for elastic adjustment of the conduit may be present in the reduced diameter end 920.

[0083] Figure 61 is a cross-sectional view of a stepped diameter conduit 900. The central portion of the conduit 910 is sandwiched by the reduced diameter end 920. The vacuum port 110 is generally located in the center of the central portion of the conduit 910. A series of openings 260 for elastic adjustment of the conduit may be present in the reduced diameter end 920.

[0084] Figure 62 is a top view of the carrier 930 for the end-rounded conduit. The carrier 930 for the end-rounded conduit has a partial cylindrical surface 990. The combination of the partial cylindrical surface 990 and the floating jaw portion 950 forms a full cylindrical boss around which the rounded end 220 of the conduit 200 having a rounded edge is wrapped. The unfolding tab 240 is held in place by the unfolding tab retaining boss 970. A flexible retainer 960 wraps around the partial cylindrical surface 990 and the floating jaw portion 950. A vacuum control port 650 is located at the top.

[0085] Figure 63 is a side view of the carrier 930 for the end-rounded conduit. The unfolding tab 240 is held in place via the unfolding tab retaining boss 970. A flexible retainer 960 is used to firmly hold the partial cylindrical surface 990 to the floating jaw 950, which holds the conduit 200 with the rounded edge in an open position.

[0086] Figure 64 is a cross-sectional view of the carrier 930 for the end-rounded conduit. The floating jaw portion 950 has an inverted separator 940 inside the conduit 200 having a rounded edge. A vacuum channel 980 is present throughout the component. The flexible retainer 960 has a thread loop 1870 which is kept taut by a retaining spring 1860, which is secured by a spring hook 1585.

[0087] Figure 65 is a cross-sectional view of the carrier 930 for the end-rounded conduit. The rounded end 220 is rounded to wrap around the end of the floating jaw portion 950. The reverse separator 940 passes through the vacuum port 110 of the conduit 200 having the rounded edge. The flexible retainer 960 passes around the floating jaw portion 950.

[0088] Figure 66 is a perspective view of the large gap repair structure 1000. The nerve stump 410 is partially located inside the large gap conduit 1010. Fixation sutures 890 are shown at the end of the large gap conduit 1010.

[0089] Figure 67 is a side view of the large gap repair structure 1000. The nerve stump 410 is partially located inside the large gap conduit 1010. Fixation sutures 890 are shown at the end of the large gap conduit 1010.

[0090] Figure 68 is a cross-sectional view of the large gap repair structure 1000. Within the large gap conduit 1010, a regeneration gap 895 exists between the nerve ends 410 of the nerves.

[0091] Figure 69 is a perspective view of the pull-cut blade 1020. The reverse cutting edge 1030 is shielded from the outside of the pull-cut blade 1020.

[0092] Figure 70 is a perspective view of a lever carrier housing 1710 having a separator. It has an internal vacuum channel 775, a pair of jaw pivot bosses 1570, a vacuum control port 650, and a fixed separator 800.

[0093] Figure 71 is a side view of a lever carrier 1700 having a separator. It has a lever operating carrier housing 1710 with a separator, a pair of lever jaws 1520, a vacuum connecting cylinder 610, a lever spring 1530, and a vacuum valve 1590, and holds a conduit 1540 having two end tabs.

[0094] Figure 72 is a detailed view of a lever carrier housing 1700 having a separator. It has a pair of lever jaws 1520 and a conduit 1540 having two end tabs, with a fixed separator 800 located inside.

[0095] Figure 73 is a perspective view of the completed long defect repair 1200. The nerve stump 410 is partially located inside each conduit 100. Furthermore, each conduit 100 also encloses one end of the nerve allogeneic graft 1220.

[0096] Figure 74 is a side view of the completed long defect repair 1200. The nerve stump 410 is partially located inside each conduit 100. Furthermore, each conduit 100 also encloses one end of the nerve allogeneic graft 1220.

[0097] Figure 75 is a cross-sectional view of the completed long defect repair 1200. The nerve stump 410 is partially located inside each conduit 100. Furthermore, each conduit 100 also encloses one end of the nerve allogeneic graft 1220. Within the conduit, a regeneration gap 895 exists on each side of the nerve allogeneic graft 1220.

[0098] Figure 76 is a side view of the carrier stand 1300. A carrier pipe recess 1310 having a carrier pipe feed channel 1330 is present. It has a carrier stand base 1320.

[0099] Figure 77 is a perspective view of the carrier stand 1300. A carrier pipe recess 1310 having a carrier pipe feed channel 1330 is present. It has a carrier stand base 1320.

[0100] Figure 78 is an end view of the lap conduit 1400. The lap conduit 1400 has a helical wall 1410 and at least one continuous support tab 1420. The inner helical end 1425 overlaps with the helical wall 1410.

[0101] Figure 79 is a perspective view of the lap conduit 1400. The lap conduit 1400 has a helical wall 1410 and at least one continuous support tab 1420. A vacuum port 1430 is present, penetrating the helical wall 1410.

[0102] Figure 80 is a perspective view of a lap conduit 1400 having two helical end tabs 1565. It has a helical wall 1410 and at least one continuous support tab 1420.

[0103] Figure 81 is a side view of the lever operating carrier 1500. It consists of a vacuum connection cylinder 610 and a lever operating carrier housing 1510. It has a pair of lever jaws 1520 and a lever spring 1530.

[0104] Figure 82 is a perspective view of the lever operating carrier 1500. It consists of a vacuum connection cylinder 610 and a lever operating carrier housing 1510. It has a pair of lever jaws 1520, a lever spring 1530, and a sliding vacuum valve 1590. The lever operating carrier 1500 holds a conduit 1540 having at least two end tabs, or any of several other embodiments of the carrier, such as conduits 100, 170, and 1900.

[0105] Figure 83 is an exploded view of the lever carrier 1500. It consists of a vacuum connection cylinder 610 and a lever operating carrier housing 1510. It has a pair of lever jaws 1520 and a lever spring 1530. It has a vacuum control port 650 with a sliding vacuum valve 1590. It holds a conduit 1540 with two end tabs. An internal vacuum channel 775 can be seen inside the lever operating carrier 1510. Furthermore, the lever operating carrier housing 1510 also has two jaw pivot bosses 1570. The lever jaw 1520 has a jaw pivot hinge recess 1580. A movable separator can be fitted to this carrier.

[0106] Figure 84 is a top view of the lever operating carrier 1500. It consists of a vacuum connection cylinder 610 and a lever operating carrier housing 1510. It has a pair of lever jaws 1520 and a lever spring 1530. It holds a conduit related to a conduit 1540 having two end tabs.

[0107] Figure 85 is a cross-sectional view of the lever carrier 1500. It consists of a vacuum connection cylinder 610 and a lever operating carrier housing 1510. It has a pair of lever jaws 1520 and a lever spring 1530. It has a vacuum control port 650 with a sliding vacuum valve 1590. It holds a conduit 1540 with two end tabs. An internal vacuum channel 775 can be seen inside the lever operating carrier housing 1510. Furthermore, the lever operating carrier housing 1510 also has a jaw pivot boss 1570. The lever jaw 1520 is in the released position.

[0108] Figure 86 is a side view of a conduit relating to a conduit 1540 having two end tabs 1550. The conduit 1540 has a vacuum port 110. Near each open end 150, the end tabs 1550 are positioned 180 degrees apart, i.e., at 3 o'clock and 9 o'clock. Furthermore, the conduit 1540 also includes a support tab 1560 around the vacuum port 110. This is an alternative embodiment of the tab arrangement, using jaws with multifaceted contact surfaces at 8 o'clock and 10 o'clock.

[0109] Figure 87 is an end view of a conduit 1540 having two end tabs. It has 180-degree tabs 1550 at two midlines at each end. It has a tab (or support tab) 1560 supporting the port on one side and a retaining tab 130 on the other side. In the center there is an open end 150 for the nerve stump.

[0110] Figure 88 is a perspective view of a conduit 1540 having two end tabs. It has a vacuum port 110. It has a tab 1550 at a 180-degree angle to the center line. It has a tab 1560 supporting the port around the vacuum port 110.

[0111] Figure 89 is a side view of the simple conduit holder 1650. It has a shaft handle 1655, a simple separator 1670, a vacuum opening 1660, and an expanded separator area 1680. The contact surface 1720 is adjacent to the expanded separator area 1680.

[0112] Figure 90 is a side view of a simple conduit holder 1650, a conduit 1695 with a circular vacuum port, a simple separator 1670, and an extended separator region 1680.

[0113] Figure 91 is a cross-sectional view of a simple conduit holder 1650 and a conduit 1695 having a circular vacuum port. An internal vacuum channel 1690 extends through the simple conduit holder handle 1655. A simple separator 1670 is located inside the conduit 1695 having a circular vacuum port.

[0114] Figure 92 is a detailed view of the simple conduit holder 1650, the conduit 1695 with a circular vacuum port, the simple separator 1670, and the extended separator region 1680. The contact surface 1720 is adjacent to the extended separator region 1680. The vacuum opening 1660 of the simple separator 1671 is shown.

[0115] Figure 93 is a perspective view of a multi-port conduit 1800. It has multiple vacuum ports 110. It has multiple retaining tabs 130.

[0116] Figure 94 shows a conduit 1810 having connected tabs, which has a vacuum port 110. Each connected tab 1820 has radial tab segments 1830 located at each end and connecting segments 1840 that connect them and create an open trapping recess 1850.

[0117] Figure 95 is a perspective view of a conduit with a double vacuum port. The conduit 1875 with the small port is a cylindrical conduit. There are two or more small vacuum ports 1880 sized to match the double post separator.

[0118] Figure 96 is a perspective view of conduit 1885 having a slit. It is cylindrical and has a slit 1890 for a separator. The slit is curved so as not to interfere with the separator.

[0119] Figure 97 is a perspective view of a conduit having dovetail tabs in the open position. The conduit 1900 having dovetail tabs is a cylindrical implant. It has a series of dovetail tabs 1910 formed from dovetail tab recesses 1920 around its circumference. The conduit has a lateral opening, i.e., a vacuum port 110 located approximately in the middle of the conduit's length. Adjacent to this, at least one vacuum port flap 120 may be present to close it after implantation.

[0120] Figure 98 is a perspective view of a conduit with a dovetail tab in the closed position. The conduit 1900 with the dovetail tab is in an embedded state, with the dovetail tab folded to 1950. A vacuum port flap 160 is shown.

[0121] Figure 99 is an end view of a conduit 1900 having dovetail tabs in the open position. It has a series of dovetail tabs 1910 and a transition from a dovetail tab base 1930 to a larger dovetail tab end 1940, allowing tabs of varying cross-sections to engage with a retaining device.

[0122] Figure 100 is an end view of a conduit 1960 having stepped tabs in the open position. It has a series of stepped tabs 1970, which allow the tabs to engage with a retaining device.

[0123] The conduits in Figures 5 to 11 are substantially cylindrical in shape to capture the severed nerve ends. Conduits 100, 170 have vacuum ports 110 to create a low-pressure region within the conduit, drawing in the nerve ends 410 without requiring any other manipulative force. The conduits have external bosses 130 that allow for support of the conduit so that they do not collapse when an internal vacuum is applied. These tabs are distributed outward to provide balanced support. The tabs are sandwiched between or interlocked with carrier instruments 600, 50 to mechanically maintain the cylindrical shape of the conduits.

[0124] Variations of fixed tabs 100 and bendable tabs 170 exist, which can be fabricated from various biocompatible materials. The material used to shape the conduit is silicone or another polymer. Cut tabs 180 are more suitable for bioabsorbable fiber conduits and can be die-cut or laser-cut. After cutting, they are bent outward to provide contact with the instrument. The processing of bioabsorbable conduits is often only suitable for creating uniform walls, and small features cannot be easily accommodated. Cutting is an economical and clean process. A jig may be used to push out the tabs during the instrument loading operation. The conduits are loaded into the instrument by the manufacturer and sterile-packaged. The end user, who is a surgeon, does not need to perform this cumbersome loading operation.

[0125] The vacuum port 110 may have adjacent molded or cut-out flaps 120. The instrument keeps these open during joining. They can then fold and close naturally after the instrument is separated, closing the port 160. The closed flaps tend to allow cells to continue advancing within the duct.

[0126] The conduit may have multiple vacuum ports 1800 for joining nerves, with or without separators. The vacuum ports may be a matrix of small holes inside the boundaries of the vacuum ports 110.

[0127] The conduits 100 and 170 have a diameter in the range of 1 to 10 mm and a length in the range of 5 to 100 mm. Longer conduits have more series of outer support tabs 130 than shown in Figures 5 to 8 in order to maintain a cylindrical cross-section.

[0128] The conduits shown in Figures 12–16 maintain their cylindrical shape by bent ends 220 on a cylindrical retaining device 930. They have a vacuum port 100 and, due to 360-degree support, can be used in extremely flexible conduits, such as those made from silicone 200. The rounded ends provide a vacuum-proof seal. The radius of the bend acts as a centering bevel for the nerve stump, resulting in extremely easy installation. Integrated deployment tabs 240 are used to remove the conduits 200 with rounded edges. They contact the device during implantation and are later pulled away, extending the edges to their extended position. The natural position of the conduit is the deployed state, and since it is molded in that way, it behaves like a simple hose piece and attempts to return to this shape. The tabs are removed after the conduit is fully extended 300.

[0129] The end-rounded conduit 300 may have an opening 260 near its end. These windows 260 allow that portion of the conduit to be rounded more easily. They also serve the secondary purpose of reducing the likelihood of pinching nerves when the conduit is located in a place where nerves move, as the nerves must bend with the body when the skeleton moves, by changing the stiffness of the conduit. These windows may be used in conjunction with conduits that are not rounded. The windows may penetrate the wall of the conduit completely or partially.

[0130] All or part of the vacuum tube can be formed inside the conduit and may be removed after being embedded.

[0131] The size measuring instrument 350 is shown in Figures 17 to 22. The size measuring instrument is a device for measuring the diameter of a nerve stump. It consists of a U-shaped recess 380 into which the nerve root 410 is inserted. If the nerve fits too loosely, the nerve is too small; if the nerve does not fit, it is too large. This allows for the measurement of the nerve stump without the use of an optical scale, i.e., a ruler. The arm 360 is thin to allow for use in small patients and small wounds, making the repair less invasive and resulting in faster recovery compared to repairs that use a relatively large ruler or estimate of nerve size. The size measuring instrument makes the measurement by having approximately 180 degrees of contact with the nerve root in the U-shaped stump receiving section 380. The fitting of the nerve stump in the receiving section may be done by touch or visually. The advantage is that all the user needs to do is determine whether a gap exists in each receiving section. There is also a redundant check to verify whether the reference plane 390 is tangent to the nerve, which is a simple top or bottom determination. The tangent may be determined by touching it with a finger. The sizing instrument relies on checking the stump in two dimensions at once. This eliminates errors that may occur if the stump is inadvertently flattened during the measurement process, resulting in a reading that is too low or too high. The sizing instrument loosely holds the stump in a roughly circular section. The recesses are typically in 1-millimeter increments from 2 mm to 6 mm, but can be larger or smaller. Similar to how a fidget spinner toy is held and spun, the hub 370 is held between the thumb and other fingers, and the arms are quickly rotated to find the correct size.

[0132] The scar trimmer 450 shown in Figures 23 to 32 allows for efficient one-handed excision of stumps. Scarred or irregularly shaped torn nerve endings 580 do not heal as well as newly excised stumps. The trimmer has a non-exposed blade 500 or 510 having a cavity 480 for fully supporting the stump to be excised. The cavity may be round or V-shaped 595 so that the tool can be used for stumps of various sizes. The cavity 595 may be a closed cavity or an open cavity. The blade may be actuated by being pushed, or conversely, the blade 1020 may be pulled to cut the stump. The blade may have an inclined blade or be vertically straight so that the linear motion of the blade has an oblique shear component. The blade may have a non-serrated or serrated edge. The opening may have a textured surface to prevent the nerve from moving during the cutting operation. Housings 455 and 460 may be screwed together, or integrated snap-fit ​​fasteners may be used for more economical and quicker assembly. The surfaces facing the blade 490 provide support on each side, i.e., a desired double shear condition.

[0133] The actuation button 470 is typically pressed with the thumb to advance the blade. A spring 530 is present to return the blade to the retracted position. After the nerve has been severed, the blade retracts into the housing. An industry-standard blade 500 may be used in the trimmer, and a blade number 10 is shown in the drawing. A specially designed blade 510 may be used to shorten the operating stroke and to optimize cutting efficiency, which is driven primarily by the blade tip angle. The trimmer allows for the cutting of very thin sections of scar and nerve to expose fresh cells, while maintaining the length of the stump as much as possible.

[0134] A conduit carrier 600 is shown in Figures 33 to 55. Its primary purpose is to hold the conduit and facilitate its placement. The carrier supports the conduit by capturing the area of ​​the conduit at numerous points in order to maintain a cylindrical inner diameter. Preferably, an external tab 130 engages with a recess 870 between the carrier jaws 660. The jaws 660 may be a cylinder divided into two to six segments.

[0135] The interior of the carrier is hollow 775 throughout its entire length. At one end, the carrier is connected to an easily accessible suction source in the operating room by sliding in a boss. The hollow chamber 775 passes through the jaw of the instrument, through a vacuum port in the wall of the conduit 100, and to the center of the conduit.

[0136] The carrier is positioned so that the stump is close to the conduit entrance 150. Once the stump is properly positioned, the fingers are placed over the port 650, and the pressure inside the conduit decreases. The diameter of the nerve stump and the narrow gap between it and the conduit restrict the inflow of air, and the vacuum, i.e., the pressure difference, pulls the stump towards the center of the conduit without the need for manual pushing or pulling or the use of sutures. The other side is pulled in the same way. To prevent the first nerve from completely blocking the vacuum port and thus making the second junction impossible, a separator 710 or 800 is placed where the stump is ideally positioned.

[0137] When correcting positioning, continuous or intermittent use of the vacuum port 650 may be useful. The vacuum valve 1590 may be used to function as a fixed port cover and to continue applying vacuum bonding force without requiring fingers. This frees up the surgeon's hand and allows the suture 890 to be placed between the epineurial membrane and the conduit to stabilize the structure.

[0138] If, after ligation, the depth indicator mark is 2 millimeters from the exposed end of the conduit, this indicates that the end of the stump is adjacent to the separator and properly positioned for optimal healing. If the mark is more than 2 millimeters from the end, there may be some limitation in the nerve's ability to move into place, or the carrier is not in an ideal central position. Adjustment of the nerve and carrier will eliminate the impediment and allow for proper ligation.

[0139] The jaws 660 are held together by radial compression elements 670, preferably springs. An easily accessible slide button 640, located away from the conduit, is used to open the jaws from a position where they firmly grip the tab to a detached position while maintaining contact with the rest of the instrument. The button 640 can snap into place back and forth and can remain in either the closed or open position as desired.

[0140] The separator 710 may be integrated with a spring or button so that the separator is pulled back when the conduit is open, reducing the risk of the repair being disrupted by a small hand movement.

[0141] The movement of the jaw releases tab 130, detaching the duct from the carrier. The duct can then exit in a straight line from its previous position. A carrier exiting in a straight line requires only a small incision.

[0142] The carrier fits in the hand like a pencil. The majority of the carrier's length is a tube 610, which may be metal or plastic and may be assembled with a pin 700 or other metal fittings. The tube and housing may be made as a single piece or entirely of plastic and may snap together while maintaining a vacuum-sealing seal. A silicone sleeve 620 covering the metal handle is optional for the surgeon's comfort and for a better grip of the instrument. The sleeve may be ergonomically designed.

[0143] There is some space 790 around the spring that allows air to enter the vacuum chamber, slightly reducing the overall vacuum available for joining, but not significantly reducing the joining capability. The same is true for the gap between the cut end and the conduit, and the small gap 905 does not hinder joining.

[0144] Figures 40 to 44 show the operation of the spring 670 and the separator 710. The jaw portion 660 has recesses for maintaining the closed position 750 and the open position 760. The interlocking between the release button and the spring can be seen. The tab sandwiched between the jaw portions can also be seen. The wire separator 710 is integrated with the spring and fits through the vacuum port 110 in the conduit wall.

[0145] The central housing vacuum channel 775 can be seen in the cross-sectional view 45, and the spring shares the vacuum channel.

[0146] Figure 46 shows the conduit carrier central housing, which is the main gripping component and has a recess 780 for positioning the movable separator. It has a smooth outer surface to facilitate gripping and a cross-section with a width and height between 8 mm and 25 mm. It may be molded from polymer for lightweight purposes.

[0147] Figure 47 shows an alternative embodiment of the fixed separator, which can be combined with a simplified version of spring 670.

[0148] The joining process is shown in Figures 48 to 51. In Figure 50, the nerve on the left is fully joined to the separator, while the nerve on the right is partially joined.

[0149] Figure 51 shows the clamping points of the tabs between the supporting jaws. The tabs are shown in their neutral (uncompressed) positions. The true positions of the tabs are deformed to fit into the gaps in the jaws. The contact surfaces of the conduit carrier central housing 630 are inclined to avoid shearing of the tabs. The clamping angle of the surfaces of the recess 870 of the conduit carrier central housing 630 is 30 degrees and may be between 0 and 90 degrees.

[0150] Detailed jaws are shown in Figures 52-55. Two identical jaws 660 are used on the carrier 600. The jaws engage with other carrier components on surface 865. Optional interlocking mechanisms 765 and 770 are present on the jaws at the 3 o'clock position in Figure 52. These maintain the rigidity of the instrument during handling and use. The distance from the conduit cylinder to the hinge is 9 millimeters and can range from 5 to 200 millimeters. The partial cylindrical boss 765 of the jaws has a variety of diameters to support conduits of various sizes. The jaws are sized to work with conduits with a diameter of 4 mm. The length of the partial cylindrical boss is typically three times the diameter of the conduit, but can range from 5 mm to 50 mm.

[0151] Completed direct repairs with a conduit and two nerve stumps are shown in Figures 56–58. The junction is completed with the nerve stumps positioned inside the conduit, with a regeneration gap 895 that is between 0.1 and 5 mm, ideally about 1 mm, which is the width of the separator. The nerve stumps have nearly equal contact with the conduit. Sutures for holding the conduit in place are shown spaced around the edge 890. The vacuum port flap 160 is shown in the closed position and is smooth on the inside and outside of the conduit.

[0152] The vacuum bonding process results in a smaller radial gap 905 compared to conventional suture pulling techniques, which may require the conduit to be 1-3 millimeters larger. This is likely to occupy less space within the wound and reduce the growth of axons in the wrong direction down the radial gap 905.

[0153] The bonding force is calculated by multiplying the cross-sectional area inside the conduit by the difference between the pressure inside the vacuum chamber and atmospheric pressure. A typical hospital operating room suction system operates with 150 millimeters of mercury. The results for each stump are shown in Table 1 below. These forces allow the stump to move easily into place without overloading the body structure or damaging the stump. [Table 1]

[0154] A stepped diameter conduit 900 is shown in Figures 59–61. Windows 260 near both ends enhance the ability of the area to stretch to a larger diameter. The windows are away from the vacuum port 110 and do not completely impede the ability to perform vacuum bonding. A reduced diameter end 920 may be smaller than the nominal size of the nerve stump and may be used to hold the conduit to the stump with little or no additional suturing. Care must be taken not to overcompress the nerve at the end and cause damage. The vacuum port is central and works in conjunction with the vacuum bonding device. In this embodiment, a set of vacuum port flaps 120 may be used, and external tabs may also be used to maintain the shape. The diameter of the end is shown as 0.5–4 mm smaller than the diameter of the central portion of the conduit, which is in the range of 2–10 mm. The constituent material is typically flexible silicone or bioabsorbable fiber woven fabric.

[0155] A carrier 930 for the rounded conduit is shown in Figures 62–65. The rounded end 220 of the conduit emerges from the outside of a two-piece cylinder formed by the fitting of a partial cylindrical surface of the carrier 930 for the end-rounded conduit with a partial cylindrical surface of the floating jaw portion 950. The rounded end is wrapped around each end of the formed cylinder, providing full radial support for the conduit 200. The deployment tab 240 is held out of the way on a dedicated boss, but on a boss 970 that is slightly larger than the tab opening, making it easily accessible for deployment. The deployment tab is grasped by the larger tab and moved away from the conduit along the nerve. The tab pulls the deployed end outward, and as it is pulled, it deploys all the way around. The tab is in contact with about 20 percent of the rounded end, and may be between 5 and 50 percent. With both ends deployed, both deployment tabs are excised. The conduit holds the cylindrical components 950 and 990 together.

[0156] Optionally, the floating jaw portion 950 may be fixed away from the conduit and held on the housing by a stretched flexible retainer (high-strength thread) 960 which is cut to release the jaw portion. The thread is attached to a spring 1860 to maintain tension on the jaw portion. The thread provides a large force to hold the jaw portion immobile while being extremely small in size and requiring no additional components. The jaw portion may have an interlocking mechanism for axial stability. The stabilizer 940 may be on the floating jaw portion as shown in the figure, or on the housing side. A sliding separator can be attached to this embodiment. When the thread is cut, the housing is removed from the repair site and the floating jaw portion is recovered from the repair site.

[0157] An alternative embodiment of the conduit carrier has jaws that may have inwardly facing bosses that sandwich material between windows, in order to allow maintenance of the conduit diameter without relying on the outer tabs on the conduit 900. The release and operation of this embodiment are otherwise the same as those of a tabbed conduit.

[0158] The divided contact surfaces can be aligned with the vacuum channel axis.

[0159] The completed long-gap nerve repair structure 1000 is shown in Figures 66-68. For severely damaged nerves typical of crush injuries, the practitioner may choose to leave a gap of 20-30 millimeters. To achieve this, the large-gap conduit 1010 and the matching carrier are extended to a diameter between 1.5 and 10 millimeters and a length between 15 and 50 millimeters. The vacuum-assisted bonding process is the same as in the case of direct repair. Suturing of the conduit to the nerve is performed as in the case of direct repair. The large-gap conduit may be silicone or bioabsorbable and may have a wall thickness of 0.2 to 4 millimeters.

[0160] A pull-cutting blade 1020 for a scar trimmer is shown in Figure 69. This is an alternative embodiment to the push blade, performing cutting with a pull stroke instead of a push stroke. Although the pull blade is slightly more difficult to manufacture than the outer cutting edge, it may allow the trimmer to fit into smaller wounds.

[0161] The use of conduits 100 and nerve grafts 1220 in defects ranging from 20 to 30 millimeters, up to a maximum of 70 millimeters, is shown in Figures 73 to 75. When the gap of growable nerve exceeds 2 centimeters, the preferred method is to place a nerve graft between the stumps. This requires twice the effort in the role of the surgeon. This surgery is streamlined by using the present invention in connecting each conduit to the nerve graft. Vacuum bonding is performed between the graft and the stump. Repair is presumably performed sequentially. Graft-stump repair functions very similarly to direct repair.

[0162] A carrier support stand 1300 is shown in Figures 76 and 77. It functions as a tripod and therefore has a wide base for stability, the base having two spaced-apart contacts 1320, the third being the conduit carrier. The carrier support stand engages with the carrier by positioning a vacuum connection cylinder (handpiece) within the upper carrier tube recess 1310. A feed channel covers and fits into the mating portion 610, preventing the mating portion from falling out. It can rotate around the carrier and move closer to or further away from the conduit to change the holding angle. A light interlocking fit maintains the relative position and allows for easy sliding for adjustment. The depth of the stand is between 3 and 15 millimeters. The base is between 25 and 75 millimeters wide and between 25 and 250 millimeters high. It is preferably made from polycarbonate or another polymer. It may have a variant with an inclined carrier tube recess. Other means of connection to the carrier may be available. The stand replaces the surgical assistant who would normally need to position the carrier during the fixation process. The stand is more stable than holding the carrier by hand, making fixation easier.

[0163] Alternative embodiments of the lap conduits 1400 and 1450 are shown in Figures 78 and 79. Lapp conduits are another common method for joining stumps. If the lap 1400 has spaced radial tabs 1420 around its circumference and maintains a generally cylindrical shape, the vacuum joining of the carrier can be adapted to the lap. Tabs may be present at the inner ends of the spiral to produce a diameter larger than the resting diameter. When the instrument releases the tabs, the lap conduit returns to its original size from when it was created. Both the radial tabs and the tabs resulting from the ends are captured by an instrument similar to the instrument used by the continuous wall conduit 100. This has a similar vacuum port 100 and joining method. Lapp conduits have the ability to repair nerves of various sizes, and the nominal inner diameter of the lap conduit can be varied by several millimeters, making sizing less critical. This may be better for nerves with unusual shapes. This size range allows for the treatment of patients with a small hospital stock. The internal helical end 1425 may have chamfered corners to reduce nerve compression. The internal helical end 1425 moves between the 4 o'clock and 8 o'clock positions. The illustrated 4 o'clock position is when the inner diameter is at its maximum size to facilitate nerve junctions. The tabs may be shorter in the lap conduit 100, as shown in the retaining tab 130. Lap conduits with helices having more turns than illustrated can be fitted to the carrier device.

[0164] A carrier for a lap conduit 1450 with end tabs may have a stepped opening, where the end tabs 1565 of the helix are released first, allowing the inner diameter to close to some extent, and a second release completely opens the conduit. This allows for a better vacuum joint because the radial gap 905 is smaller.

[0165] An alternative embodiment of the carrier is the lever carrier 1500 shown in Figures 81-85 and 70-72. The lever jaw 1520 on the carrier pivots 12 millimeters from the central axis of the conduit and has a range of 8-200 millimeters. The alternative capture and release mechanism is performed via a lever that holds and releases the conduit. A clothespin-like spring 1530 is used to provide force to fix the jaw before implantation. Vacuum is controlled via a finger-operated vacuum port.

[0166] The carrier may have a vacuum valve 1590 and may or may not have a separator 800. The separator may not be necessary for repairing large gaps.

[0167] If the central housing is approximately the same width as the conduit, the spacing between the internal vacuum channels may be extremely wide, making joining possible without a separator.

[0168] The jaws may consist of three parts: an internal vacuum channel and two movable jaws, or they may have only two movable jaws, each comprising half of the central vacuum channel. The lever jaws may have a catch so that once the lever is squeezed, the lever remains open and held in the orientation shown in Figure 85. The movable separator is compatible with the lever carrier device. Figure 72 shows the two contact surfaces on the outer surface at the 3 o'clock and 9 o'clock positions. The carrier housing and tube may be molded as a single unit.

[0169] Alternative embodiments of the conduit are shown in Figures 86–88. Tabs near the conduit ends are 180 degrees apart and located in a single plane, and only two are needed at the 3 o'clock and 9 o'clock positions, as shown in Figure 87. This tab arrangement works with more rigid conduits. The number of tabs adjacent to the vacuum port is three, located approximately equally spaced at the 3 o'clock, 8 o'clock, and 10 o'clock positions. The additional tabs provide a good vacuum seal. This is the conduit used for the lever carrier in Figures 81–85. The conduit has a vacuum port and may have a flap to close it after implantation. The conduit may have a separator in its center, which is part of the conduit material and remains during repair. The separator may be a small thread or thread matrix that restricts joining but does not hinder cell growth. The separator may be a thread or suture that is pulled during implantation but removed before the completion of repair.

[0170] Embodiments of the carrier's lever jaws illustrate another embodiment for holding a conduit in a ready position. While the first embodiment had three substantially equally spaced tabs 130 around the outside of the conduit, the 180-degree jaw variant has multiple regions of tab shape. The conduit closest to the vacuum port has three substantially equally spaced tabs 1560, with two tabs 1550 on the outer edge. This configuration works in conduits with walls of sufficient rigidity to support themselves. The variant with three tabs can better support thin conduits that are difficult to support themselves, particularly when high vacuum is used. The three tabs near the conduit vacuum port better seal the inside of the conduit with the carrier's vacuum channel. The jaws for mating with 1540 have three contact surfaces, located at 3 o'clock and 9 o'clock at the end and at 3 o'clock, 8 o'clock and 10 o'clock near the separator (not shown).

[0171] Instead of a dedicated spring, a taut thread can be used to hold the hinged jaws together. Instead of cutting, the thread may be released by removing the anchor loop.

[0172] The pull thread used with the floating jaw or lever jaw may be looped over the boss immediately after crossing the jaw contact surface, so that, as shown in FIG. 64, instead of half of the loop, a small amount of thread needs to be pulled past the repaired nerve.

[0173] A carrier without a separator and a conduit with a vacuum port flap function when the vacuum is strong enough to pull the flap open to join the nerves. This is how an ordinary industrial flap valve functions.

[0174] Alternative embodiments of the conduit carrier are shown in FIGS. 89-92. The simplified device has no moving parts. It has a tubular handpiece 1650, a separator 1670, a contact surface 1720, and a geometric interlock material 1680. This is combined with a conduit having a round vacuum port. The carrier may be screwed into the vacuum port or, if the interlock material is not screwed in, the sheet may be covered and the conduit pressed against the contact surface. The interlock material may be part of a handle or other part whose effective cross-sectional area can be changed by a remote operating lever, a collet, or similar means. Engagement or disengagement is effected by retracting the handle or unscrewing the handle.

[0175] The separator 1670 contacts the opposite side of the internal channel and provides a location where the nerve stumps do not directly contact each other, preventing the growth of the axonal growth cone from being retarded or hindered. The separator has a vacuum path 1660 that allows air movement from both sides of the conduit. The carrier is connected to a vacuum pipe and has an internal vacuum channel 1690. This embodiment is most suitable for conduits made of self-supporting materials and wall thicknesses because the instrument has no additional radial support.

[0176] A conduit 1800 with multiple vacuum ports is shown in Figure 93. It has tabs 130 for maintaining its shape. It has multiple vacuum ports 110 for independently having direct vacuum bonding forces. The multiple ports do not require the use of separators to properly position the stumps, but the surgeon must center the conduit before bonding. This is combined with a central housing modification to the carrier shown in Figure 33 or Figure 81. This technique may be more suitable for repairing large gaps where the conduit is longer than illustrated.

[0177] A conduit having connected tabs 1820 is shown in Figure 94. The space forming the capture recess 1850 can facilitate loading the conduit into the carrier. The connecting segments may be excised or left at the surgeon's discretion. Radial tab portions 1830 are shown only near the ends of the conduit, but 1 to 8 tabs may be present along the length of the conduit.

[0178] The surgical method disclosed herein includes the step of excising a scar. To excise the scar, the trimmer 450 is slid across the end of the nerve stump. The actuation button 470 is pressed to cut off the damaged tissue. If no growable cells are visible across the entire surface of the stump, the cutting is repeated. The trimmer allows for very thin slices. The process is repeated at the other stump.

[0179] Using a surgical marker, another step is to mark the nerve stump approximately 7 millimeters from the freshly excised end. Repeat this at the other stump. This is used later in this technique to confirm proper fusion.

[0180] To measure the diameter of the nerve root, the nerve is placed in the U-shaped recess at the end of the arm of the size measuring instrument 350. Proper fitting means that the nerve fits snugly and its top surface is tangential.

[0181] The selected conduit is slightly larger than the nerve, about 0.5 millimeters larger.

[0182] Another step is to connect the conduit carrier 600 to the vacuum supply unit in the operating room using a suction line.

[0183] If the conduit is bioabsorbable, wet the material by placing it in physiological saline.

[0184] Another step is to position the conduit carrier between the ends of the cut.

[0185] Another step is to move the carrier very close to one of the stumps.

[0186] Another step is to close the vacuum control port 650 with a finger, and the nerve stump advances into the captured conduit 170 with the bent tab. For further bonding force, another finger is placed on the other side of the conduit.

[0187] Another step is to bring the conduit carrier closer to the second nerve stump and close the vacuum control port, allowing the second nerve to enter the conduit. The conduit carrier has a separator 710 that positions the nerve terminal in the appropriate position for regeneration. The movable retractor 710 does not put too much stress on the repair when the carrier is removed. The fixed separator 800 properly orients the nerve terminal for regrowth.

[0188] It should be noted that, depending on the body's structure, simultaneous connection of both nerves is possible.

[0189] Furthermore, if necessary, the duct is sutured to the epineurial membrane. The carrier is then released from the duct and gently retracted from the wound.

[0190] An alternative or optional step in this surgical method may include engaging the carrier's vacuum valve to hold the stump in the conduit without requiring the port to be covered and fingers held, as this keeps the stump in the optimal junction position by keeping the port closed.

[0191] The carrier stand 1300 fits onto the carrier tube and functions as a tripod due to its wide base, holding the carrier in place without requiring continuous gripping of the component by the surgical assistant. Even small movements of the assistant's hand can make suturing more difficult and may take several minutes to complete. The carrier and carrier stand can be inverted to the opposite side of the hand, allowing the suture to be placed in other parts of the conduit.

[0192] Alternatively, the conduit may be used to connect one end of the graft to the stump, and another conduit to connect the other end of the graft.

[0193] Exemplary embodiments of the present invention The following examples illustrate various exemplary embodiments and combinations of aspects of the present invention described herein and shown in Figures 5 to 100. More specifically, the following provides examples of conduits, conduit carriers, nerve sizing instruments, scar trimmers, and methods for performing nerve repair surgery using them, as described herein and shown in Figures 5 to 100.

[0194] Examples of conduits for nerve repair surgery Conduits 100 (Figure 5), 170 (Figure 9), 200 (Figure 12), 900 (Figure 59), 1400 (Figure 79), 1540 (Figure 86), 1695 (Figure 91), 1800 (Figure 93), 1810 (Figure 94), 1875 (Figure 95), 1885 (Figure 96), 1900 (Figure 97), and 1960 (Figure 100) according to one or more aspects of the present disclosure include a conduit body comprising first and second open ends 150 facing opposite directions and a hollow conduit interior extending between them. The conduit interior is configured to receive a first nerve stump 410 (Figure 50) through the first open end 150 and a second nerve stump 410 through the second open end 150 during a patient's nerve repair surgery.

[0195] The first and second nerve stumps 410 may include a nerve stump 410 inserted through one of the first or second opening ends 150 of the conduit 100 and a nerve allograft 1220 (Figs. 73 - 75) inserted into the other of the first and second opening ends 150 of the conduit 100. The nerve allograft (or nerve graft) 1220 can be used to connect two nerve stumps 410 that are too far apart to be connected by a single conduit 100. For example, a combination of two conduits 100 and a nerve allograft 1220 may be used to connect two nerve stumps 410 that are up to 70 millimeters apart.

[0196] The first and second nerve stumps 410 may include a proximal nerve stump and a distal nerve stump. The proximal nerve stump is positioned closer to the skeleton than the distal nerve stump. Nerve cells, such as axonal nerve cells, generally grow from the proximal nerve stump. The distal nerve stump generally receives nerve cells that grow outward from the proximal nerve stump.

[0197] A vacuum port 110 (Fig. 5) extends through the outer wall 140 of the conduit body. The vacuum port 110 is connected to a vacuum source (not shown) associated with the conduit carriers 600 (Fig. 33), 1500 (Fig. 83) and is configured to draw a vacuum inside the conduit when inserting the nerve stumps 410 into the first and second opening ends 150.

[0198] At least one radial support structure 130 (Fig. 5), 220 (Fig. 12) is disposed on the outer wall 140 of the conduit body. The at least one radial support structure 130, 220 is configured to structurally support the conduit body when a vacuum is applied.

[0199] At least one radial support structure of the conduit may be any support structure configured to structurally support the conduit body when a vacuum is applied. However, some specific embodiments of the at least one radial support structure are discussed and illustrated throughout this specification and the drawings.

[0200] During nerve repair surgery, a vacuum is used to generate low pressure inside the conduit 100 in order to draw the first and second nerve stumps 410 into the first and second open ends 150 of the conduit. The conduit 100 is often made of a flexible material to improve patient comfort and to allow bending of the patient's body part into which the conduit is implanted. The problem is that when a vacuum is applied, the flexible body of the conduit 100 tends to collapse before the nerve stumps 410 can be inserted.

[0201] However, conveniently, at least one radial support structure, such as one or more retaining tabs 130 or a pair of bent ends 220, may be used to provide structural support to the conduit 100. Furthermore, the radial support structures 130, 220 may be designed to engage with the conduit carriers 600, 1500 to further maintain the shape of the conduit when a vacuum is applied inside the conduit.

[0202] In some embodiments of the conduit, at least one vacuum port flap 120 (Figure 5) is configured to cover and close the vacuum port 110 when no vacuum is applied. More specifically, the vacuum port flap 120 can cover and close the vacuum port 110 when the nerve repair surgery is complete. When the vacuum port flap 120 covers and closes the vacuum port 110, the vacuum port flap 120 prevents nerve cells from the first and second nerve stumps 410 from growing through the vacuum port 110.

[0203] Multiple vacuum port flaps 120 may be present, configured to cover and close a single vacuum port 110. For example, as shown in Figures 5 and 6, there may be first and second vacuum port flaps 120 positioned on either side of the vacuum port 110. The first and second vacuum port flaps 120 may close over the vacuum port flaps 120 and abut each other in the center of the vacuum port 110.

[0204] In some examples of the conduit 1800 (Figure 93), the vacuum port 110 may include first and second vacuum ports 110 (Figure 93) separated by a predetermined distance. As will be described in more detail herein, the separated vacuum ports 110 are used to accommodate a larger regeneration gap 985 (Figure 68) between the first and second nerve stumps 410.

[0205] In some examples of the conduit, at least one radial support structure 130, 220 includes at least one retaining tab 130 positioned on the outer wall 140 of the conduit body. At least one retaining tab 130 is configured to engage with the jaws 660 (Figures 33-37), 1520 (Figures 81-85) of the conduit carriers 600, 1500. For example, the jaws 660, 1520 may sandwich the retaining tab 130.

[0206] In some examples, at least one retaining tab 130 includes a first set of retaining tabs 130 positioned close to the first open end 150 of the conduit 100 and a second set of retaining tabs 130 positioned close to the second open end 150 (see Figures 5 to 8). The vacuum port 110 is located in the center of the conduit body between the first set of retaining tabs 150 and the second set of retaining tabs 150. In some examples of the conduit, the first set of retaining tabs 130 may include three tabs 130 positioned on the outer wall 140 of the conduit body at intervals of 60 to 180 degrees (see the left side of the conduit 100 in Figure 5). Furthermore, the second set of retaining tabs may include three tabs 130 positioned on the outer wall 140 of the conduit body at intervals of 60 to 180 degrees.

[0207] In some examples of the conduit, at least one retaining tab opening 190 (Figure 9) is located in the outer wall 140 adjacent to at least one retaining tab 180 (Figure 9). At least one retaining tab 180 is foldable into at least one retaining tab opening 190 (Figure 10).

[0208] In some examples of the conduit, at least one retaining tab 180 comprises a plurality of retaining tabs 180, and at least one retaining tab opening 190 comprises a plurality of retaining tab openings 190. Each of the plurality of retaining tabs 180 is foldable into a related adjacent retaining tab opening 190 of the plurality of retaining tab openings 190.

[0209] In some examples of the conduit 1400 (Figures 78-80), at least one retaining tab includes a continuous support tab 1420 that extends longitudinally along the length of the conduit body from a first open end 150 to a second open end 150. As will be described in more detail herein, these continuous support tabs 1420 may be positioned on the conduit 1400 having a helical wall 1410.

[0210] In some examples of the conduit 1810, at least one retaining tab includes a connecting tab 1820. The connecting tab 1820 includes first and second radial tab portions 1830 extending radially outward from the outer wall 140. Furthermore, the connecting tab 1820 includes a connecting tab portion 1840 integrally connected to the first and second radial tab portions 1830 and extending longitudinally between them. The connecting tab 1820 and the outer wall 140 define a capture recess 1850 open between them. The capture recess 1850 can facilitate loading the conduit 1810 into the conduit carriers 600, 1500. The connecting tab portion 1840 may be excised or left in place at the surgeon's discretion.

[0211] In some examples of the conduit 1900 (Figure 99), at least one retaining tab includes a dovetail tab 1910. The dovetail tab 1910 includes a lower tab (bottom of the tab 1910) and an upper tab (top of the tab 1910). The lower tab is attached to the outer wall 140 and has a first width. The upper tab has a second width. The second width is greater than the first width in order to provide a dovetail shape.

[0212] In some examples of the conduit 1960 (Figure 100), at least one retaining tab includes a stepped tab 1970. The stepped tab 1970 includes a lower tab portion and an upper tab portion. The lower tab portion is attached to the outer wall 140 and has a first width. The upper tab portion is positioned above the lower tab portion. The upper tab portion has a second width. The second width is greater than the first width in order to provide a stepped shape.

[0213] In some examples of the conduit 1400 (Figures 78-80), the conduit body includes a helical wall 1410. The helical wall 1410 includes a first wall end extending in the longitudinal direction and a second wall end extending in the longitudinal direction. The first wall end overlaps with and abuts against the second wall end (see Figure 78) to form the interior of a hollow conduit.

[0214] In some examples of conduits, the conduit includes a stepped diameter conduit 900 (Figures 59-61). The stepped diameter conduit 900 includes a first open end 920 having a first inner diameter. Furthermore, the conduit 900 also includes a second open end 920 having a second inner diameter. A central portion 910 of the conduit body is located between the first end 920 and the second end 920. The central portion 910 has a third inner diameter. In the stepped diameter conduit 900, the first and second inner diameters are smaller than the third inner diameter. In the examples in Figures 59-61, the first and second inner diameters of the first and second open ends 920 are substantially equal.

[0215] Furthermore, the stepped diameter conduit 900 may include a plurality of first elastic adjustment openings 260 located at the first open end 920 (left side of the conduit 900). The first elastic adjustment openings 260 are configured to provide predetermined elasticity to the first open end 920 (left side of the conduit 900). Furthermore, the conduit 900 may include a plurality of second elastic adjustment openings 260 located at the second open end 920 (right side of the conduit 900). The second elastic adjustment openings 260 are configured to provide predetermined elasticity to the second open end (right side of the conduit 900). The predetermined elasticity may be used to fix the conduit 900 to the nerve stump 410 without requiring additional sutures.

[0216] The first and second elastic openings 260 can at least partially penetrate the wall of the conduit 900. The openings 260 can have various shapes, but a rectangle is shown in Figure 61. Material removal makes the area of ​​the reduced diameter end 920 more flexible than the stepped conduit 900 without the openings 260. The parameters of the openings vary to allow the conduit 900 to lightly hold the nerve stump 410 over a wider diameter range than the conduit 900 without the openings 260.

[0217] In some examples of the conduit 200, the conduit includes an end-rounded conduit 200 (Figures 12-16). In the end-rounded conduit 200, at least one radial support structure includes a first open end 920 configured to be rounded back onto itself 220 from a first extended position (Figure 15, left) to a first rounded-back position (Figure 12, left). At the first rounded-back position, the first open end 290 forms a first nerve entry region 230 (Figure 12, left) configured to structurally support the conduit body when a vacuum is applied and to receive a first nerve stump 410.

[0218] Furthermore, at least one radial support structure further includes a second open end 920 configured to be rounded back onto itself 220 from a second extended position (Figure 15, right) to a second rounded-back position (Figure 12, right). At the second rounded-back position, the second open end 290 forms a second nerve inlet region 230 (Figure 12, right) configured to structurally support the conduit body when a vacuum is applied and to receive a second nerve stump 410.

[0219] The end rounding conduit 200 includes a first unfolding tab 240 detachably connected to the first distal end of the first open end 290 (left side of Figure 15). The first unfolding tab 240 is configured to provide a lever for rounding the first open end 290 from a first extended position (Figure 15) to a first rounded-back position (Figure 12). Furthermore, the end rounding conduit 200 also includes a second unfolding tab 240 detachably connected to the second distal end of the second open end 290 (right side of Figure 15). The second unfolding tab 240 is configured to provide a lever for rounding the second open end 290 from a second extended position (Figure 15) to a second rounded-back position (Figure 12).

[0220] Furthermore, the rounded end conduit 200 may further include a plurality of first elastic adjustment openings 260 located at the first open end 290. The first elastic adjustment openings 260 are configured to provide a predetermined elasticity to the first open end 290. Furthermore, the rounded end conduit 200 may further include a plurality of second elastic adjustment openings 260 located at the second open end 290. The second elastic adjustment openings 260 are configured to provide a predetermined elasticity to the second open end 290. The predetermined elasticity may be used to fix the conduit 200 to the nerve stump 410 without requiring additional sutures.

[0221] Examples of conduit carriers for nerve repair surgery Conduit carriers 600 (Figure 33), 840 (Figure 48), 930 (Figure 62), 1500 (Figure 83), 1650 (Figure 89), and 1700 (Figure 71) according to one or more aspects of the present disclosure include carrier housings 630 (Figure 33), 1510 (Figure 83), 1655 (Figure 89), and 1710 (Figure 71) comprising first and second contact ends and vacuum channels 775 (Figures 45, 70, and 83), 1690 (Figure 91) extending between them. The vacuum channels 775 are configured to be connected to a vacuum source via the first contact ends. Engagement mechanisms 660 (Figure 33), 1520 (Figure 83), 1680 (Figure 92), and 1520 (Figure 72) are connected to the second contact ends. The engagement mechanisms 660, 1520, 1680, and 1520 are configured to be releasably engaged with conduits 170 (Figure 33), 1540 (Figure 83), 1695 (Figure 92), and 1540 (Figure 72) during nerve repair surgery on the patient.

[0222] The engagement mechanism of the conduit carrier may be any mechanism configured to engage with the conduit in a releasable manner. However, several specific embodiments of the engagement mechanism are discussed and illustrated throughout this specification and the drawings.

[0223] Furthermore, the conduit carriers 600, 1500, 1650, and 1700 conveniently include separators 710 (Figure 40), 1510 (right end of housing 1510 in Figure 83), 1670 (Figure 92), and 800 (Figure 70). The separators are configured to extend from the second contact end. During nerve repair surgery, when the engagement mechanisms 660, 1520, 1680, and 1520 engage with the conduits 170, 1540, 1695, and 1540, i. Vacuum channels 775 and 1690 are connected to the vacuum ports of conduits 170, 1540, 1695, and 1540 via second contact ends, allowing a vacuum source to draw a vacuum of 850 (Figure 50) into the conduit. ii. Separators 710, 1510 (at their distal ends), 1670, and 800 extend through the vacuum port 110 into the interior of the conduits 170, 1540, 1695, and 1540, providing a predetermined regeneration gap 895 (Figure 58) between the first and second nerve stumps 410 inserted into the conduits.

[0224] The separators 710 and 800 conveniently provide a clear stopper to which the nerve stump 410 can be brought into contact (see Figure 50, where the left nerve stump 410 is in contact with separator 710 and the low-pressure area 850 remains open). This allows for the formation of a more precise regeneration gap 895 than in previous prior art systems and methods.

[0225] In some examples of the conduit carriers 600, 1500, and 1700, the engagement mechanism includes first and second jaws 660 (Figure 33), 1520 (Figures 71 and 83) connected to the carrier housings 630, 1510, and 1710. The first and second jaws 660, 1520 are movable between a jaw closed position (Figures 33, 71, and 81) and a jaw open position (Figures 35 and 85). In the jaw closed position, the first and second jaws 660 and 1520 are configured to engage with the conduits 170 (Figure 34) and 1540 (Figures 72 and 82), and the separators 710 (Figure 41), 1510 (Figure 83, its right tip), and 800 (Figure 70) extend between the first and second jaws 660 and 1520 into the interior of the conduits 170 and 1540. In the jaw open position, the first and second jaws 660 and 1520 are configured to release the conduits 170 and 1540 (see Figure 36).

[0226] As will be described in more detail herein, in the example of the conduit carrier 600, the separator is movable from an extended first position (Figure 40) to a retracted or retracted second position (Figure 44). In the first position, the jaws 660 are closed around the conduit 170, and the separator 710 extends into the interior of the conduit 170 through the vacuum port 110. In the second position, the jaws 660 are open, and the separator 710 is retracted from the conduit 170.

[0227] In contrast, in the examples of conduit carriers 1500 and 1700, the separator 800 is an integral part of the carrier housings 1510 and 1710 and has a fixed position relative to the housings 1510 and 1710. More specifically, the separator 800 is the extended right end of the carrier housings 1510 and 1710 (i.e., the contact end of the housings 1510 and 1710 that engages with the conduit 1540).

[0228] In some examples of the conduit carriers 600, 1500, the first and second jaws 660, 1520 are laterally movable relative to the carrier housings 630, 1510, 1710 between a jaw closed position (Figures 40, 81) and a jaw open position (Figures 44, 85). In other words, the jaws 660, 1520 move laterally from the side of the carrier housings 630, 1510, 1710. The lateral movement of the jaws 660, 1520 may also be rotational. That is, the jaws 660, 1520 may be pivotally supported at one end to allow both rotation and lateral movement relative to the carrier housings 630, 1510, 1710.

[0229] Conveniently, when the jaws 660, 1520 move from the jaw closed position to the jaw open position, the first and second jaws 660, 1520 are configured not to extend further longitudinally into the patient's body to release the conduits 170, 1540. In other words, unlike prior art conduit carriers (see Figures 2 and 3), the jaws 660, 1520 of the present invention do not need to extend further into the patient's body for release. The primarily lateral movement of the jaws 660, 1520 relative to the conduit housings 630, 1510 reduces the risk of patient injury during nerve repair surgery.

[0230] In some examples of the conduit carrier 600, the second contact end of the carrier housing 630 (i.e., the end of the carrier housing 630 that engages with the conduit 170) includes a conduit contact surface 810 (Figure 47). The conduit contact surface 810 is configured to conform to the shape of the conduit 170. Furthermore, the separator 710 is configured to extend through the conduit contact surface 810. The conduit contact surface 810 and the first and second jaws 660 substantially surround the conduit 170 when the first and second jaws 660 are in the closed position (Figure 40).

[0231] In some examples of the conduit carriers 1500, 1700, the carrier housings 1510, 1710 include first and second jaw pivot bosses 1570 located on either side of the carrier housings 1510, 1710. The first and second jaw pivot bosses 1570 are configured to engage with the first and second jaws 1520, respectively, to provide fulcrums that allow the first and second jaws 1520 to pivot between their respective jaw closed and jaw open positions. Lever springs 1530 (Figure 83) are located within the carrier housings 1510, 1710. The lever springs 1530 are configured to engage with the first and second jaws 1520, biasing the first and second jaws to pivot to their respective jaw closed positions.

[0232] In some examples of conduit carriers 600, 1500, and 1700, when the jaws 660 and 1520 are in the closed position, the first and second jaws engage with at least one radial support structure 130 of the conduit 1540 to structurally support the conduit 1540 when a vacuum is applied. In some examples of conduit carriers, the at least one radial support structure comprises at least one retaining tab 130 located on the outer wall 140 of the conduit body. Conveniently, the combination of conduit carriers that engage with the radial support structure of the conduit helps prevent the conduit from collapsing when a vacuum is drawn into the conduit.

[0233] In some examples of the conduit carrier 600, the first jaw portion 660 includes a first jaw contact surface 865 (Figures 52-55) located at the distal end of the first jaw portion 660. Furthermore, the first jaw portion 660 includes a first tab capture recess 870 located at the first jaw contact surface 865. The second jaw portion 660 includes a second jaw contact surface 865 located at the distal end of the second jaw portion 660. Furthermore, the second jaw portion includes a second tab capture recess 870 located at the second jaw contact surface 660. When the first and second jaw portions 660 are in the closed position, the first and second jaw contact surfaces 865 abut each other, and the first and second tab capture recesses 870 surround and capture at least one retaining tab 130. By surrounding the retaining tab 130 within the tab capture recess 870, the conduit carrier 600 more reliably maintains the shape and position of the conduit 170 during nerve repair surgery compared to systems and methods of the prior art.

[0234] Figures 97–100 show alternative outlines for radial tabs. The dovetail tab 1910 has a larger width at its distal end and a smaller width at the conduit wall, with a straight taper at the transition between the larger and smaller widths. The stepped tab 1970 has a stepped outline with two different widths, widening away from the wall. Both of these tabs 1910, 1970 interlock with the tab-retaining recess 870. Thus, there is a variant of compression or interlocking fit that does not allow the tabs 1910, 1970 to slip inward during joining, thus preventing crushing, rather than relying on frictional fitting to the carrier.

[0235] In some examples of the conduit carrier 600, a jaw spring 670 (or a separator and jaw spring 670) having a first spring position (Figure 40) and a second spring position (Figure 44) is located within a vacuum channel 775 (Figure 45) of the carrier housing 630. The jaw spring 670 includes first and second cantilever springs 720 (Figures 40, 44, and 45) on either side of the jaw spring 670. Furthermore, the jaw spring 670 includes a separator 710 located between the first and second cantilever springs 720. When in the first spring position (Figure 40), the first and second cantilever springs 720 bias the first and second jaws 660, respectively, to the jaw closed position, and the separator 710 extends into the interior of the conduit 170. When in the second spring position (Figure 44), the first and second cantilever springs 720 bias the first and second jaws 660 to the jaw open position, respectively, and the separator 710 is pulled back from inside the conduit 170.

[0236] In some examples of the conduit carrier 1650 (Figures 89-92), the engagement mechanism includes a second contact end having a threaded portion 1680 (Figure 92) through which the separator 1670 extends. The threaded portion 1680 is configured to screw into the vacuum port 110 of the conduit 1695.

[0237] In some examples of conduit carriers, the separators 710, 800 have a separator width between 0.1 and 5 millimeters, and a given regeneration gap 895 is substantially equal to the separator width. Conveniently, the separators 710, 800 provide a clear stopper to the nerve stump 410 when inserted into the conduit 100, and thus provide more precise control of the regeneration gap 895 than prior art systems and methods.

[0238] In some examples of the conduit carrier 1700, the separator 800 may include first and second separators 800 (not shown) extending parallel to the end of the conduit carrier 1700. The first and second separators 800 each have first and second separator widths and are spaced apart by a predetermined distance. The first and second separators 800 are configured to pass through first and second vacuum ports 110 (Figure 93) of the conduit 1800, respectively. Thus, a predetermined regeneration gap 895 is substantially equal to the predetermined distance between the first and second separators 800 plus the first and second separator widths. The two parallel separators 800 provide a clear stopper for the nerve stump 410, having a regeneration gap 895 that is larger than the width of a single separator 800. For example, the regeneration gap 895 may be between 5 and 10 millimeters.

[0239] In some examples of the conduit carrier 930 (Figures 62-65), the conduit carrier 930 may be a conduit carrier 930 for end-rounded conduits 200 (Figures 12-16). The mounting mechanism of the conduit carrier 930 may include a partial cylindrical surface 990, a floating jaw portion 950, and a flexible retainer 960.

[0240] The partial cylindrical surface 990 is positioned at the second contact end of the conduit carrier 930 (i.e., the contact end that engages with the conduit 200). The partial cylindrical surface 990 is configured to fit onto a first portion of the outer surface of the end-rounded conduit 200 when the conduit 200 is attached to the partial cylindrical surface 990.

[0241] The floating jaw portion 950 is configured to fit onto a second portion of the outer surface of the rounded end conduit 200 when the rounded end conduit is attached to the partial cylindrical surface 990. The partial cylindrical surface 990 and the floating jaw portion 950 are configured to substantially surround the rounded end conduit 200 when attached to the conduit carrier 930.

[0242] The separator 940 may extend longitudinally from either the partial cylindrical surface 990 or the floating jaw portion 950. That is, the separator 940 may protrude from the partial cylindrical surface 990 of the main body of the conduit carrier 930, or from the concave surface of the floating jaw portion 950.

[0243] The flexible retainer 960 is attached to a retainer spring 1860 located within the carrier housing of the conduit carrier 930 and is spring-biased by the retainer spring 1860. The flexible retainer 960 is wrapped around the floating jaw portion 950 and configured to elastically secure the rounded end conduit 200 between the floating jaw portion 950 and the partial cylindrical surface 990. The combination of the floating jaw portion 950 and the partial cylindrical surface 990 substantially surrounds the rounded end conduit 200.

[0244] Furthermore, the carrier housing of the conduit carrier 930 may include first and second deployment tab retaining bosses 970 located on both sides of the carrier housing. The first and second deployment tab retaining bosses 970 are configured to removably secure the first and second deployment tabs 240 of the end-rounded conduit 200 when the end-rounded conduit 200 is attached to the conduit carrier 930.

[0245] As described herein with reference to Figures 12–16, the end-rounded conduit 200 includes first and second open ends 290 configured to be rounded back over itself from a first extended position (Figure 15) to a first rounded-back position (Figure 12). When the end-rounded conduit 200 is attached to the conduit carrier 930 and the first and second open ends 290 are in the first and second rounded-back positions, respectively (Figures 12 and 65), the first and second open ends 290 are rounded to cover both sides of the partial cylindrical surface 990 and the floating jaw portion 950 (Figure 65), as shown in Figure 65, forming a rounded-back end 220. Thus, the combined lateral ends of the partial cylindrical surface 990 and the floating jaw portion 950 provide 360-degree structural support (Figure 65) to the end-rounded conduit 200 during nerve repair surgery.

[0246] In some examples of the conduit carrier 600, the conduit carrier includes a vacuum control port 650 located on the carrier housing 630. The vacuum control port 650 extends through the carrier housing 630 to a vacuum channel 775. When a vacuum source is drawing a vacuum into the conduit 170 through the vacuum channel 775, the vacuum pressure inside the conduit 170 is controlled when an operator's finger (not shown) is placed on the vacuum control port 650. Thus, the vacuum pressure may be controlled by hand during nerve repair surgery. For continuous junctions where it is not necessary to hold a finger on the carrier, the port may be omitted.

[0247] In some examples of conduit carriers, the conduit carrier 1500 may include a carrier stand 1300 (Figures 76 and 77) for supporting the conduit carrier 1500 during nerve repair surgery. The carrier stand 1300 includes a carrier base 1320 (or carrier stand base 1320) having at least first and second legs for supporting the carrier stand 1300 in an upright position. A stem extends vertically upward from the carrier base 1320. Carrier housing sections 1310 and 1330 are located at the upper end of the stem. The carrier housing sections 1310 and 1330 include an elastic carrier tube feed channel 1330 and a carrier tube recess 1310. The elastic carrier tube feed channel 1330 is configured to allow frictional passage of a portion of the carrier housing 1510. The carrier tube recess 1310 is integrally connected to the carrier tube feed channel 1330. The carrier pipe recess 1310 is configured to receive and secure a portion of the carrier housing 1510 that has passed through the carrier pipe feed channel 1330.

[0248] Examples of nerve size measuring instruments for nerve repair surgery A nerve size measuring instrument 350 according to one or more embodiments of the present disclosure (Figures 17-22) includes a plurality of U-shaped recesses 380. Each of the plurality of U-shaped recesses 380 is configured to receive a nerve stump 410 having a diameter up to a predetermined maximum nerve stump diameter that is different from any of the other maximum nerve stump diameters for any of the other recesses 380. In other words, the U-shaped recesses 380 of the nerve size measuring instrument 350 may be sized to receive a nerve stump 410 having a predetermined maximum diameter, and no two recesses 380 are sized to receive the same maximum nerve stump diameter.

[0249] In some examples of the nerve sizing instrument 350, each of the U-shaped recesses 380 of the multiple recesses is sized to match a different maximum nerve stump diameter. In some examples of the nerve sizing instrument 350, each U-shaped recess 380 has a recess depth and recess width equal to the maximum nerve stump diameter with respect to the recess 380.

[0250] Conveniently, the depth and width of the U-shaped recess 380 are equal to the maximum diameter of the nerve stump 410 relative to the size of the recess, so that the top surface of the recess 380 is tangent to the upper part of the nerve stump 410 that fits best into the recess 380 (see Figure 22). Therefore, the surgeon can determine the diameter of a properly fitted stump 410 simply by feeling with their hand that the upper part of the nerve stump is at the same height as the top of the recess 380. With this nerve sizing instrument 350, the surgeon does not need to actually look at the nerve stump to determine its size.

[0251] In some examples of the nerve size measuring instrument 350, the maximum diameter of the nerve stump with respect to each of the U-shaped recesses 380 increases in increments of 1 millimeter for each adjacent recess 380.

[0252] In some examples of the nerve sizing instrument 350, the nerve sizing instrument includes a central hub 370. Multiple arms 360 extend radially from the hub 370. Each of the multiple U-shaped recesses 380 is located at the end of each of the multiple arms 360.

[0253] Example of a scar trimmer for nerve repair surgery A scar trimmer 450 according to one or more aspects of the present disclosure (Figures 23-29 and 69) includes longitudinally extending housing assemblies 455, 460 having a front end (right end in Figure 23) and a rear end (left end in Figure 23). The front end has a front boss 490. The front boss 490 includes a stump cutting cavity 480 located within the front boss. The stump cutting cavity 480 is configured to receive a nerve stump 410, which extends through the stump cutting cavity 480. An internal slider 560 is located inside the housing assemblies 455, 460. The internal slider 560 is movable between an anterior and a rear position relative to the housing assemblies 455, 460. A blade 500 is slidably held by the internal slider 560. As the nerve stump 410 extends through the stump cutting cavity 480 and the internal slider 560 moves between a posterior and anterior position, the blade 500 slides through the stump cutting cavity 480 and excises the scarred end of the nerve stump 410.

[0254] In some examples of the scar trimmer 450, the internal slider 560 further includes an actuation button 470. The actuation button 470 protrudes through the housing assemblies 455, 460 and is slidably positioned on the housing assemblies. The actuation button 470 is configured to manually move the internal slider 560 between a posterior and anterior position to excise the scarred end of the nerve stump 410.

[0255] In some examples of the scar trimmer 450, the internal slider 560 further includes a blade capture boss 540 located in front of the actuation button 470. The blade capture boss 540 slidably captures the blade 500. Furthermore, the internal slider 560 includes a spring capture loop 535 located behind the actuation button 470. A spring 530 is located within the spring capture loop 535. When the internal slider 560 is manually moved from the rear position to the front position, the blade 500 slides forward through the stump cutting cavity 480, excising the scarred end of the nerve stump 410. When the actuation button 470 is manually released, the spring 530 biases the internal slider 560 from the front position to the rear position, causing the blade 500 to slide backward out of the stump cutting cavity 480.

[0256] In some examples of the scar trimmer 450, the blade 1020 (Figure 69) is a pull-cutting blade 1020 captured by an internal slider 560. As the internal slider 560 is moved from an anterior to a posterior position, the blade 1020 slides posteriorly through the stump cutting cavity 480, excising the scarred end of the nerve stump 410.

[0257] In some examples of the scar trimmer 450, the stump cutting cavity 480 includes an open stump cutting recess (or V-shaped recess) 595 integrally connected to a stump cutting access slot 590 (Figure 30). The stump cutting access slot 590 is configured to hook the nerve stump 410 into the stump cutting recess 595 to position it so that it can be excised by the blades 500, 1020.

[0258] The scar trimmer housing assemblies 455, 460 may include scar trimmer housing sides 450 and scar trimmer housing notched sides 460 that serve as contact areas for the nerve stump 410 when extending the nerve stump 410 through the stump cutting cavity 480 in either a closed or open embodiment. The blade 500 may move between the scar trimmer housing sides 450 and the scar trimmer notched sides 460 of the housing assemblies 455, 460 as the blade slides forward or backward through the stump cutting cavity 480. Thus, the forward force of the blade 500 results in cutting without causing the nerve stump 410 to slip out of place.

[0259] An example of how to perform nerve repair surgery on a patient. Referring to Figure 101A, a flowchart of a method 2000 according to several aspects of the present disclosure for performing nerve repair surgery on a patient is shown. The method begins in 2002, in which a first nerve stump 410 is placed in a U-shaped recess 380 of a nerve sizing instrument 350, and the diameter of the first nerve stump 410 is determined.

[0260] If the U-shaped recess 380 has a depth and width equal to a predetermined maximum diameter of the nerve stump 410 that can fit into the recess 380, the diameter of the first nerve stump 410 can be determined by hand. More specifically, the diameter of the nerve stump 410 may be determined by sensing that the top of the nerve stump 410 is at the same height as the top of the U-shaped recess 380.

[0261] The diameter of the second nerve stump 410, which will be joined to the first nerve stump, may also be determined in a similar manner. However, this step may not be necessary, as the two nerve stumps 410 are likely to be substantially the same diameter.

[0262] In method 2004, conduits 100, 170, 200 and conduit carriers 660, 930, 1500, 1650, 1700 are selected based on the diameter of the determined first nerve stump 410.

[0263] In 2006, the selected conduits 100, 170, and 200 are releasably engaged with the selected conduit carriers 660, 1500, 1650, and 1700. The releasable engagement of the selected conduits 100, 170, and 200 with the selected conduit carriers 660, 1500, and 1700 may be performed, for example, in an operating room during nerve repair surgery. Alternatively, the releasable engagement may be performed before the start of nerve repair surgery, for example, at a remote location such as a medical device factory or logistics facility.

[0264] In 2008, the first separators 710 and 800 of the conduit carriers 660 and 1500 are extended into the vacuum port 110 of the conduit 100. Extending the first separators 710 and 800 into the vacuum port 110 of the conduit 100 may be performed, for example, in an operating room during nerve repair surgery. Alternatively, this extension may be performed before the start of nerve repair surgery, for example, at a remote location such as a medical device factory or logistics facility.

[0265] In 2010, the vacuum channels 775 of the conduit carriers 660 and 1500 are connected to the vacuum port 110 of the conduit 100. Connecting the vacuum channels 775 to the vacuum port 110 may be done, for example, in an operating room during nerve repair surgery. Alternatively, this connection may be made before the start of nerve repair surgery, for example, at a remote location such as a medical device factory or logistics facility.

[0266] In 2012, a vacuum of 850 is introduced into the conduit 100 via the vacuum channel 775.

[0267] In 2014, the first and second nerve stumps 410 are inserted into the first and second open ends 150 of the conduit 100, respectively, while a vacuum 850 is applied.

[0268] In 2016, a first separator 800 is used to provide a predetermined regeneration gap 895 between the first and second nerve stumps 410. The first separator may have a separator width between 0.1 and 5 millimeters, and the predetermined regeneration gap 895 may be substantially equal to the separator width.

[0269] Referring to Figure 101B, a continuation of the flowchart of Method 2000 according to some aspects of the present disclosure is shown, and some of the steps shown may or may not be required, or may or may not be used.

[0270] This method may be followed by the 2018 method, in which the first and second nerve stumps 410 are extended into the stump cutting cavity 480 of the scar trimmer 450.

[0271] In method 2000, the scar trimmer 450 blade 500 can be slid through the stump cutting cavity 480 to excise the scarred ends of the first and second nerve stumps 410. The excision of scar tissue from the nerve stumps 410 is performed before inserting the nerve stumps 410 into the conduit 100.

[0272] In 2022, the conduit bodies of the selected conduits 100, 200 may be structurally supported when a vacuum is applied by at least one radial support structure 130, 220 positioned on the outer wall 140 of the conduit body.

[0273] At least one radial support structure may include at least one retaining tab 130. At least one retaining tab 130 may be releasably engaged with the first and second jaws 1520 of the conduit carrier 1500 to structurally support the conduit body when a vacuum of 850 is applied.

[0274] In 2024, to prevent nerve cells from the first and second nerve stumps 410 from growing through the vacuum port 110, the vacuum port flap 120 may be closed by covering the vacuum port 110 when no vacuum is applied.

[0275] In 2026, the conduit 100 may be opened by moving the first and second jaw portions 1520 laterally relative to the carrier housing 1510 of the conduit carrier 1500, so that the first and second jaw portions 1520 do not extend further longitudinally into the patient's body.

[0276] In 2028, the second separator 800 of the conduit carrier 1500 may extend into the second vacuum port 110 of the conduit 1800. The first and second separators 800 each have first and second separator widths and are spaced apart by a predetermined distance. The predetermined regeneration gap 895 is substantially equal to the predetermined distance between the first and second separators 800 plus the first and second separator widths.

[0277] It should be understood that all combinations of the aforementioned and additional concepts described in more detail herein (as long as such concepts are not contradictory) are considered to be part of the subject matter of the invention disclosed herein. In particular, all combinations of the claimed subject matter shown at the end of this disclosure are considered to be part of the subject matter of the invention disclosed herein.

[0278] While the present invention has been described by reference to specific examples, it should be understood that many modifications can be made within the spirit and scope of the ideas of the invention described herein. Therefore, this disclosure is not limited to the examples described herein and is intended to have the entire scope as defined by the following claims.

Claims

1. The conduit body includes first and second open ends facing opposite directions and a hollow conduit interior extending between them, the conduit interior being configured to receive a first nerve stump through the first open end and a second nerve stump through the second open end during nerve repair surgery on a patient, A vacuum port extends through the outer wall of the conduit body and is connected to a vacuum source associated with the conduit carrier, configured to create a vacuum inside the conduit when the nerve stump is inserted into the first and second open ends, At least one radial support structure is provided, which is positioned on the outer wall of the conduit body and configured to engage with the jaw portion of the conduit carrier, and which, by engaging with the jaw portion of the conduit carrier, provides structural support to the conduit body when a vacuum is applied. A conduit equipped with these features.

2. At least one vacuum port flap configured to cover and close the vacuum port when the vacuum is not applied. Equipped with, The conduit according to claim 1, wherein when the at least one vacuum port flap covers and closes the vacuum port, the at least one vacuum port flap prevents nerve cells from growing through the vacuum port from the first or second vacuum end.

3. The conduit according to claim 1, wherein the vacuum port includes first and second vacuum ports arranged on the outer wall of the conduit body.

4. The conduit according to claim 1, wherein the at least one radial support structure comprises at least one retaining tab disposed on the outer wall of the conduit body, and the at least one retaining tab is configured to engage with the jaw portion of the conduit carrier.

5. The at least one retaining tab is A first set of retaining tabs positioned near the first open end, A second set of retaining tabs positioned near the second open end and Equipped with, The conduit according to claim 4, wherein the vacuum port is located in the center of the conduit body between the first and second sets of retaining tabs.

6. The first set of retaining tabs comprises three tabs arranged on the outer wall of the conduit body at intervals of 60 to 180 degrees, The conduit according to claim 5, wherein the second set of retaining tabs comprises three tabs arranged on the outer wall of the conduit body at intervals of 60 to 180 degrees.

7. At least one retaining tab opening located in the outer wall adjacent to the at least one retaining tab Equipped with, The conduit according to claim 4, wherein the at least one retaining tab can be folded into the opening of the at least one retaining tab.

8. The at least one retaining tab comprises a plurality of retaining tabs, and the at least one retaining tab opening comprises a plurality of retaining tab openings, The conduit according to claim 7, wherein each of the plurality of retaining tabs can be folded into a related adjacent retaining tab opening among the plurality of retaining tab openings.

9. The at least one retaining tab is A continuous support tab extending longitudinally along the length of the conduit body from the first open end to the second open end. The conduit according to claim 4, comprising:

10. The at least one retaining tab comprises a connecting tab, and the connecting tab is First and second radial tab portions extending radially outward from the outer wall, A connecting tab portion is integrally connected to the first and second radial tab portions and extends longitudinally between them. Equipped with, The conduit according to claim 4, wherein the connecting tab and the outer wall define an opening-catching recess between them.

11. The at least one retaining tab comprises a dovetail tab, and the dovetail tab is The lower end of the tab, which is attached to the outer wall and has a first width, The upper end of the tab has a second width Equipped with, The conduit according to claim 4, wherein the second width is greater than the first width.

12. The at least one retaining tab comprises a stepped tab, and the stepped tab is The lower part of the tab, which is attached to the outer wall and has a first width, A tab upper portion having a second width is positioned above the tab lower portion. Equipped with, The conduit according to claim 4, wherein the second width is greater than the first width.

13. The conduit body is provided with a helical wall, and the helical wall is, A first wall end extending in the longitudinal direction and a second wall end extending in the longitudinal direction Equipped with, The conduit according to claim 1, wherein the first wall end overlaps with and abuts against the second wall end to form the hollow interior of the conduit.

14. The conduit comprises a stepped diameter conduit, and the stepped diameter conduit is The first open end having a first inner diameter, The second open end having a second inner diameter, The central portion of the conduit body, which is positioned between the first and second ends and has a third inner diameter, Equipped with, The conduit according to claim 1, wherein the first and second inner diameters are smaller than the third inner diameter.

15. A plurality of first elastic adjustment openings are arranged at the first opening end and configured to provide a predetermined elasticity to the first opening end, A plurality of second elastic adjustment openings are provided at the second opening end and configured to provide a predetermined elasticity to the second opening end, A stepped diameter conduit according to claim 14, comprising the features described above.

16. The conduit comprises a conduit with rounded ends, and the at least one radial support structure is It is configured to roll back onto itself from a first extended position to a first rounded-back position, and at the first rounded-back position, The conduit body is structurally supported when the vacuum is applied. This forms a first nerve entry region configured to receive the first nerve stump. The first open end and, It is configured to roll back onto itself from a second extended position to a second rounded-back position, and at the second rounded-back position, The conduit body is structurally supported when the vacuum is applied. This forms a second nerve entry region configured to receive the second nerve stump. The second open end and, The conduit according to claim 1, comprising:

17. A first unfolding tab is detachably connected to the first distal end of the first open end and configured to provide a lever for rolling the first open end back from the first extended position to the first rolled-back position, A second unfolding tab is detachably connected to the second distal end of the second open end and configured to provide a lever for rolling the second open end back from the second extended position to the second rounded position, The end-rounded conduit according to claim 16, comprising the features described above.

18. A plurality of first elastic adjustment openings are arranged at the first opening end and configured to provide a predetermined elasticity to the first opening end, A plurality of second elastic adjustment openings are provided at the second opening end and configured to provide a predetermined elasticity to the second opening end, The end-rounded conduit according to claim 16, comprising the features described above.

19. A carrier housing comprising first and second contact ends and a vacuum channel extending between them, wherein the vacuum channel is configured to connect to a vacuum source via the first contact end, An engagement mechanism connected to the second contact end and configured to engage with the conduit in a releasable manner during nerve repair surgery on a patient, A separator configured to extend from the second contact end and Equipped with, When the engagement mechanism is engaged with the conduit during the nerve repair surgery, The vacuum channel is connected to the vacuum port of the conduit through the second contact end, enabling the vacuum source to draw a vacuum into the conduit. The separator extends through the vacuum port into the interior of the conduit, creating a predetermined regeneration gap between the first and second nerve stumps inserted into the conduit, and is a conduit carrier.

20. The engagement mechanism comprises first and second jaws connected to the carrier housing, the first and second jaws being movable between a jaw closed position and a jaw open position. Equipped with, In the closed jaw position, the first and second jaws are configured to engage with the conduit, and the separator extends between the first and second jaws into the interior of the conduit. The conduit carrier according to claim 19, wherein in the jaw-open position, the first and second jaws are configured to open the conduit.

21. The first and second jaw portions are movable laterally relative to the carrier housing between the jaw portion closed position and the jaw portion open position. The conduit carrier according to claim 20, wherein when the jaw portion moves from the closed position to the open position, the first and second jaw portions are configured not to extend further longitudinally into the patient's body to release the conduit.

22. The second contact end of the carrier housing is provided with a conduit contact surface that matches the shape of the conduit, and the separator is configured to extend through the conduit contact surface. The conduit carrier according to claim 20, wherein the conduit contact surface, the first jaw, and the second jaw substantially surround the conduit when the first and second jaws are in the closed position.

23. First and second jaw pivot bosses are positioned on both sides of the carrier housing and are configured to engage with the first and second jaws, respectively, to provide fulcrums that allow the first and second jaws to pivot between a jaw closed position and a jaw open position, respectively. A spring is disposed on the carrier housing and configured to engage with the first and second jaws and bias the first and second jaws to pivot to their respective closed positions. The conduit carrier according to claim 20, comprising:

24. The conduit carrier according to claim 19, wherein in the closed position, the first and second jaws engage with at least one radial support structure of the conduit to structurally support the conduit when the vacuum is applied.

25. The conduit carrier according to claim 24, wherein the at least one radial support structure comprises at least one retaining tab disposed on the outer wall of the conduit body.

26. The first jaw contact surface located at the distal end of the first jaw, and The first tab-capturing recess is disposed on the first jaw contact surface. The first jaw portion comprises, The second jaw contact surface located at the distal end of the second jaw, and The second tab-catching recess is located on the second jaw contact surface. The second jaw portion comprises, Equipped with, The conduit carrier according to claim 25, wherein when the first and second jaws are in the closed position, the contact surfaces of the first and second jaws abut each other, and the first and second tab-capturing recesses surround and capture the at least one retaining tab.

27. A jaw spring having a first spring position and a second spring position within the vacuum channel of the carrier housing. Equipped with, The aforementioned jaw spring is, The first and second cantilever springs on both sides of the jaw spring, The separator located between the first and second cantilever springs and Equipped with, When in the first spring position, the first and second cantilever springs bias the first and second jaws to the jaw closed position, respectively, and the separator extends into the interior of the conduit. The conduit carrier according to claim 20, wherein when in the second spring position, the first and second cantilever springs bias the first and second jaws to the jaw open position, respectively, and the separator is pulled back from the interior of the conduit.

28. The conduit carrier according to claim 19, wherein the engagement mechanism comprises the second contact end having a threaded portion through which the separator passes, and the threaded portion is configured to be screwed into the vacuum port of the conduit.

29. The conduit carrier according to claim 19, wherein the separator has a separator width between 0.1 and 5 millimeters, and the predetermined regeneration gap is substantially equal to the separator width.

30. The separator comprises a first and a second separator having a first and a second separator width, respectively, and separated by a predetermined distance, and the first and second separators are configured to extend through the first and second vacuum ports of the conduit, respectively. The conduit carrier according to claim 19, wherein the predetermined regeneration gap is substantially equal to the predetermined distance between the first and second separators plus the widths of the first and second separators.

31. The conduit carrier comprises a conduit carrier for end-rounded conduits, and the mounting mechanism is A partial cylindrical surface located at the second contact end of the conduit carrier, configured to cover and fit a first portion of the outer surface of the end-rounded conduit when the conduit is mounted on the partial cylindrical surface, When the end-rounded conduit is mounted on the partial cylindrical surface, a floating jaw portion is configured to cover and fit over the second portion of the outer surface of the end-rounded conduit, and substantially surrounds the end-rounded conduit together with the partial cylindrical surface. The conduit carrier according to claim 19, comprising:

32. The conduit carrier according to claim 31, wherein the carrier housing includes first and second deployment tab retaining bosses located on both sides of the carrier housing, the first and second deployment tab retaining bosses are configured to removably secure the first and second deployment tabs of the end rounding conduit when the end rounding conduit is mounted on the conduit carrier.

33. The aforementioned rounded end conduit is A first open end is configured to be rolled back onto itself from a first extended position to a first rolled-back position, A second open end is configured to be rolled back onto itself from a second extended position to a second rolled-back position, and It includes, The conduit carrier according to claim 31, wherein the end-rounded conduit is attached to the conduit carrier, and when the first and second open ends are in the first and second rounded-back positions, respectively, the first and second open ends are rounded back onto the partial cylindrical surface and the ends on both sides of the floating jaw portion.

34. A vacuum control port located on the carrier housing and extending through the carrier housing to the vacuum channel. Equipped with, The conduit carrier according to claim 19, wherein when the vacuum source is drawing a vacuum into the conduit through the vacuum channel, the pressure of the vacuum inside the conduit is controlled when an operator's finger is placed on the vacuum control port.

35. The carrier stand is provided for supporting the conduit carrier during the nerve repair surgery, and the carrier stand is, A carrier base for supporting the carrier stand in an upright position, A stem extending vertically upward from the base of the carrier, A carrier housing portion located at the upper tip of the aforementioned stem and Equipped with, The carrier housing housing section is A carrier pipe feed channel configured to allow a portion of the carrier housing to pass through, A carrier pipe recess is integrally connected to the carrier pipe feed channel and configured to receive and fix the portion of the carrier housing that has passed through the carrier pipe feed channel. The conduit carrier according to claim 19, comprising:

36. A nerve size measuring instrument for measuring the size of nerve stumps during nerve repair surgery on patients, comprising multiple U-shaped recesses, A nerve size measuring instrument wherein each of the plurality of U-shaped recesses is configured to receive a nerve stump having a diameter up to a predetermined maximum nerve stump diameter that is different from any of the other maximum nerve stump diameters for each of the other recesses.

37. The nerve size measuring instrument according to claim 36, wherein each of the aforementioned recesses comprises each of the plurality of U-shaped recesses.

38. The nerve size measuring instrument according to claim 36, wherein each of the U-shaped recesses has a recess depth and recess width equal to the maximum diameter of the nerve stump with respect to the respective recess.

39. The nerve size measuring instrument according to claim 36, wherein the maximum diameter of the nerve stump with respect to each of the U-shaped recesses increases in increments of 1 millimeter for each adjacent recess.

40. The central hub and Multiple arms extending radially from the hub and Equipped with, The nerve size measuring device according to claim 36, wherein each of the U-shaped recesses is located at the tip of each of the arms of the plurality of arms.

41. A scar trimmer for excising nerve ends during nerve repair surgery on patients, A longitudinally extending housing assembly having a front end and a rear end, wherein a front boss is positioned at the front end, the front boss is positioned on a stump cutting cavity, and the stump cutting cavity is configured to receive a nerve stump extending through the stump cutting cavity, An internal slider is located inside the housing assembly and is movable between a forward position and a rearward position relative to the housing assembly. The blade, which is slidably captured by the internal slider, It is equipped with, A scar trimmer, wherein a nerve stump is extended through the stump cutting cavity, and the blade slides through the stump cutting cavity as the internal slider is moved between the posterior and anterior positions, thereby excising the scarred end of the nerve stump.

42. The internal slider further comprises an actuation button, the actuation button protruding through the housing assembly and slidably positioned on the housing assembly, The scar trimmer according to claim 41, wherein the operating button is configured to move the internal slider by hand between the posterior position and the anterior position in order to excise the scarred end of the nerve stump.

43. A blade capture boss positioned in front of the activation button, the blade being slidably captured, and A spring-loaded trapping loop located behind the aforementioned activation button. The internal slider further comprises, The spring and It is equipped with, As the internal slider is moved by hand from the rear position to the front position, the blade slides forward through the stump cutting cavity, excising the scarred end of the nerve stump. The scar trimmer according to claim 42, wherein when the operating button is released from the hand, the spring biases the internal slider from the forward position to the rearward position so as to slide the blade backward out of the stump cutting cavity.

44. The blade is a pull-cutting blade captured by the internal slider, The scar trimmer according to claim 42, wherein when the internal slider is moved from the forward position to the rearward position, the blade slides backward through the stump cutting cavity to excise the scarred end of the nerve stump.

45. The aforementioned end cutting cavity is An open end-cutting recess is integrally connected to the end-cutting access slot. Equipped with, The scar trimmer according to claim 41, wherein the stump cutting access slot is configured to hook onto the nerve stump in order to position the nerve stump within the stump cutting recess so that the nerve stump is excised by the blade.

46. A method for performing nerve repair surgery on a patient, Based on the determined diameter of the first nerve stump, the conduit and conduit carrier are selected. By drawing a vacuum into the conduit through the vacuum channel of the conduit carrier, While maintaining the aforementioned vacuum, the first and second nerve stumps are inserted into the first and second open ends, respectively. To create a predetermined regeneration gap between the first and second nerve stumps, the first separator of the conduit carrier is utilized. A method that includes [a certain feature].

47. The selected conduit is releasably engaged with the selected conduit carrier, The first separator of the conduit carrier is extended into the vacuum port of the conduit, Connecting the vacuum channel of the conduit carrier to the vacuum port of the conduit The method according to claim 46, comprising:

48. The method according to claim 47, wherein the releasably engaging, extending, and connecting are performed before the commencement of the nerve repair surgery.

49. The diameter of the first nerve stump is determined by fitting the first nerve stump into the U-shaped recess of the nerve size measuring instrument. The method according to claim 46, including the method described in claim 46.

50. Extending the first and second nerve stumps into the stump cutting cavity of the scar trimmer, The blade of the scar trimmer is slid through the stump cutting cavity to excise the scarred ends of the first and second nerve stumps. The method according to claim 46, comprising:

51. The conduit body of the selected conduit is structurally supported by at least one radial support structure located on the outer wall of the conduit body when the vacuum is applied. The method according to claim 46, comprising:

52. To prevent nerve cells from growing outward through the vacuum port from the nerve stump, the vacuum port flap is closed by covering the vacuum port when the vacuum is not applied. The method according to claim 47, comprising:

53. The aforementioned at least one radial support structure comprises at least one retaining tab, which is releasably engaged, The at least one retaining tab is engaged with the first and second jaws of the conduit carrier to structurally support the conduit body when the vacuum is applied. The method according to claim 47, further comprising:

54. The conduit is released by moving the first and second jaws laterally relative to the carrier housing of the conduit carrier so that the first and second jaws do not extend further longitudinally into the patient's body. The method according to claim 46, comprising:

55. The method according to claim 46, wherein the first separator has a separator width between 0.1 and 5 millimeters, and the predetermined regeneration gap is substantially equal to the separator width.

56. Extending the second separator of the conduit carrier into the second vacuum port of the conduit Equipped with, The first and second separators each have a first and second separator width and are spaced apart by a predetermined distance. The method according to claim 47, wherein the predetermined regeneration gap is substantially equal to the predetermined distance between the first and second separators plus the widths of the first and second separators.

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