Microsurgery
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Eleven brachial plexus lesions were repaired using end-to-side side-to-side grafting neurorrhaphy in root ruptures, in phrenic and spinal accessory nerve neurotizations, in contralateral C7 neurotization, and in neurotization using intact interplexus roots or cords. The main aim was to approximate donor and recipient nerves and promote regeneration through them. Another indication was to augment the recipient nerve, when it had been neurotized or grafted to donors of dubious integrity, when it was not completely denervated, when it had been neurotized to a nerve with a suboptimal number of fibers, when it had been neurotized to distant donors delaying its regeneration, and when it had been neurotized to a donor supplying many recipients. ⋯ Deterioration in donor-muscle motor power as a consequence of end-to-side neurorrhaphy was noted in the obstetric palsy case, when the flexor carpi radialis (donor) became grade 3 instead of grade 4. This was associated with cocontractions between it and the extensors. It took nearly 1 year to improve.
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Comparative Study
Oberlin's ulnar nerve transfer to the biceps motor nerve in obstetric brachial plexus palsy: indications, and good and bad results.
We present 7 children with obstetric brachial plexus palsy treated by transferring two motor fascicles out of the ulnar nerve to the biceps nerve. Three were male, and 4 were female. The left-side brachial plexus was affected in 4 patients, and the right side in 3 patients. ⋯ The average follow-up was 19 months (range, 13-30 months). Five children had biceps muscle >or=M(3) with active elbow flexion against gravity, and 2 children had biceps muscle
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This study describes a free flow-through flap model in the rat for use in the evaluation of the physiologic and hemodynamic characteristics of this type of flap in clinical practice. The rat is a preferred animal model because it is inexpensive, readily available, and reliable. There is no free flow-through flap model available for laboratory animals, although this model gained popularity in clinical use recently. ⋯ Survival of the flap was evaluated on postoperative day 7 by direct observation, and microangiography was performed to delineate the vascularity of the flow-through flap. The results showed that all flaps survived in the experimental group and the conventional free-flap subgroup of the control group, whereas in the graft subgroup, all flaps underwent total necrosis. The authors conclude that the flow-through epigastric flap for the rat is a simple and reliable model for future physiologic and pharmacologic studies.
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Vascularized bone graft is most commonly applied for reconstruction of the lower extremity; indications for its use in the reconstruction of the upper extremity have expanded in recent years. Between 1993-2000, 12 patients with segmental bone defects following forearm trauma were managed with vascularized fibular grafts: 6 males and 6 females, aged 39 years on average (range, 16-65 years). The reconstructed site was the radius in 8 patients and the ulna in 4. ⋯ The mean period to obtain radiographic bone union was 4.8 months (range, 2.5-8 months). Fibular grafts allow the use of a segment of diaphyseal bone which is structurally similar to the radius and ulna and of sufficient length to reconstruct most skeletal defects of the forearm. The vascularized fibular graft is indicated in patients with intractable nonunions where conventional bone grafting has failed or large bone defects, exceeding 6 cm, are observed in the radius or ulna.
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Case Reports
Versatility of rectus abdominis free flap for reconstruction of soft-tissue defects in extremities.
Rectus abdominis flaps, whose blood supply is mainly provided by superior and deep inferior epigastric vessels, are suitable not only for local transfer but also as free flaps. Based on abundant anastomoses of deep inferior epigastric vessels with other vessels such as superior epigastric vessels, lower intercostal vessels, subcostal vessels, lumbar vessels, superficial epigastric vessels, and superficial and deep iliac circumflex vessels, the rectus abdominis flap may be designed as a vertical flap, transverse flap, or oblique flap. From September 1995-October 2002, 42 free rectus abdominis flaps were transferred to reconstruct a variety of soft-tissue defects. ⋯ The donor area was closed directly in 8-10-cm-wide flaps, leaving an inconspicuous scar. Larger flaps required skin grafting. After a mean 7-month (range, 3 weeks-18 months) follow-up, all flaps have healed uneventfully, and donor abdominal morbidity is minimal.