Techniques in hand & upper extremity surgery
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Tech Hand Up Extrem Surg · Dec 2007
Case ReportsLong-term outcome of replantation of proximal-third amputated arm: a worthwhile endeavor.
We report a successful replantation of a proximal-third avulsed left arm in a 26-year-old female with maintenance of good functional, clinical, Short Form 36, and the Disabilities of the Arm, Shoulder, and Hand outcomes results at 10 years. An organized approach combining staged surgical reconstruction and intense hand therapy allowed for both successful replantation and outcome. There exist no clear guidelines in making the decision between replantation and revision amputation. ⋯ In a highly motivated patient with realistic expectation, a preoperatively intact functioning shoulder should be considered an indication for attempt at replantation. With further staged reconstruction, a helper arm can still be achieved even in an avulsion-type amputation. Current operative and perioperative aspects of microsurgical replantation and subsequent reconstruction are discussed.
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Tech Hand Up Extrem Surg · Sep 2007
ReviewTechnique of intercostal nerve harvest and transfer for various neurotization procedures in brachial plexus injuries.
Brachial plexus palsy caused by traction injury, especially spinal nerve-root avulsion, represents a severe handicap for the patient. Despite recent progress in diagnosis and microsurgical repair, the prognosis in such cases remains unfavorable. Neurotization is the only possibility for repair in cases of spinal nerve-root avulsion. ⋯ We do not osteotomize the ribs and believe that this adds to the morbidity and length of the procedure. Neurotization using intercostal nerves is a very viable procedure in avulsion injuries of the brachial plexus; however, there is some concern that in the presence of ipsilateral phrenic nerve palsy, it may lead to a significant compromise of respiratory function. In our experience, this is negligible with good long-term results.
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This article will review the basic principles and techniques of managing axillary burn contractures in both industrialized and developing nations. Surgeons specializing in hand and upper extremity surgery should be adept in treating axillary soft tissue deficits secondary to burn contractures. The focus of this article will be to provide suggestions for performing skin grafts and latissimus dorsi musculocutaneous flaps, as well as illustrate guidelines for postoperative rehabilitation.
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Tech Hand Up Extrem Surg · Sep 2007
Case ReportsSoft tissue coverage of the elbow in a developing country.
Two cases that required soft tissue coverage to the anterior aspect of the elbow are presented. A fasciocutaneous intercostal perforator chest wall flap was used for one patient when only skin and fascia coverage was required. A latissimus dorsi myocutaneous flap was used to provide soft tissue coverage and supply motor power for elbow flexion after contracture release in the other. The surgical techniques for each of these flaps are discussed in the context of addressing soft tissue traumatic injuries about the elbow in a developing country with limited resources.
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Tech Hand Up Extrem Surg · Jun 2007
Transfer of the intercostal nerves to the nerve of the long head of the triceps to recover elbow extension in brachial plexus palsy.
Restoration of elbow flexion is the first goal in brachial plexus injuries. The current procedures using nerve grafts and nerve transfers authorize more extensive repairs, with different possible targets: shoulder, elbow extension, and hand. Elbow extension is important to stabilize the elbow without the contralateral hand and allows achieving a useful grasp. ⋯ Moreover, in case of absence or insufficient (M0 to M2 according to Medical Research Council scoring) recovery of elbow flexion strength by nerve surgery, the reinnervated triceps can be transferred. We present the technique of intercostal nerve transfer to the long head of the triceps branch to restore elbow extension in brachial plexus palsy. Results concerning 10 patients are presented.