Ahmad Addosooki

Importance of early passive mobilization following double free gracilis muscle transfer.

Background: The tendinous portion of the transferred muscle following double free gracilis muscle transfer for reconstruction of prehensile function in complete paralysis of the brachial plexus has a tendency to adhere to the surrounding bed and thus impede active finger motion despite powerful contraction of the muscle per se. The purpose of this study was to evaluate the effectiveness of early postoperative passive mobilization of the tendon to prevent its adhesion and the need for tenolysis. Methods: Of 34 patients who underwent double free gracilis muscle transfer technique, the initial 19 patients (group 1) underwent the conventional postoperative management consisting of 6 weeks of immobilization, and the following 15 patients (group 2) had early passive mobilization. Postoperative active range of motion of elbow and finger joints and the incidence of tenolysis were reviewed. Results: Early passive mobilization technique in group 2 negated the need for tenolysis of the transferred muscle, whereas 10 of 38 transferred muscles in group 1 required tenolysis to improve finger motion. Before tenolysis, there was a significant difference of total active finger motion between group 1 and group 2, although there was no significant difference in the total active finger motion between group 1 and group 2 after tenolysis. Conclusion: Early passive mobilization in the postoperative period, consisting of tendon compression at the elbow and assisted resistance exercises of finger and wrist joints, can prevent postoperative adhesion and improve tendon excursion and motion of the free transferred muscle.

Role of Wrist Arthrodesis in Patients Receiving Double Free Muscle Transfers for Reconstruction Following Complete Brachial Plexus Paralysis

PURPOSE We reviewed 18 patients who had received double free muscle transfers and wrist arthrodesis to determine the effect of the stiff wrist on digital motion and function. METHODS The patients were 15 men and 3 women with a mean age of 24 years. We determined the total active motion of the metacarpophalangeal and interphalangeal joints just before performing the arthrodesis and at final follow-up. We recorded the Disabilities of the Arm, Shoulder, and Hand functional score at the same times. RESULTS All of our patients showed evidence of fusion at a mean of 12 ± 2 weeks (range, 10-15 wk). The digital mean total active motion was 39° ± 21° before arthrodesis and 49° ± 25° after arthrodesis. Preoperative Disabilities of the Arm, Shoulder, and Hand scores significantly decreased after fusion. Three cases were complicated postoperatively by wound hematoma. Five patients required wrist arthrodesis hardware removal because of skin irritation. CONCLUSIONS Wrist fusion in patients receiving double free muscle transfers resulted in improved finger range of motion and overall hand function. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Surgical technique of pedicled bipolar pectoralis major transfer for reconstruction of elbow flexion in brachial plexus palsy.

In Erb (C5-C6) type of palsy due to traumatic brachial plexus injury, function is dependent upon the ability of the arm to maneuver and stabilize the hand for action. Complete loss of power of elbow flexion after brachial plexus injuries is a severe disability. If there is control of the shoulder, elbow flexion is of major importance. Various types of procedures have been described to recover or reanimate elbow flexion for chronic or failed upper type paralysis, including free muscle transfer, unipolar and bipolar pedicled muscle transfer, and various tendon transfers. In this article, we describe the surgical technique of bipolar pectoralis major transfer and our experience with this type of transfer, wherein we prefer to transfer all components of the pectoralis major muscle including the sternocostal and clavicular origins and humeral insertion without a fascial graft by the inclusion of a strip of the rectus abdominis fascia along with the flap.

Evaluation of C5 Nerve Root Repairability in Traumatic Brachial Plexus Injuries: Proposal of an Evaluation Scoring System

We reviewed 36 traumatic brachial plexus injury patients with C5 nerve root injury. We used the choline acetyltransferase (CAT) activity measurement as a gold standard indicator of repairability to assess the reliability of the conventional techniques (preoperative clinical, electrophysiologic, and radiologic examination and intraoperative clinical and electrophysiologic examinations). We proposed a repairability scoring system composed of the correlated conventional techniques and tested the validity of this scoring system using the same reference technique (CAT activity measurement). We found no significant correlation between sensation at C5 dermatome and electromyography study with C5 repairability. On the other hand, we found a significant correlation of Tinel sign, myelography, macroscopic and microscopic examination, and electrical stimulation with C5 repairability. Based on these results, we propose a simple 21-point scoring system to evaluate the repairability of C5 nerve root that is composed of Tinel sign, myelography, macroscopic and microscopic appearance, and electrical stimulation. The scoring system was found to be highly significantly correlated with C5 repairability. We concluded that our proposed evaluation scoring system is a reliable method for C5 repairability evaluation, and it can replace sophisticated techniques.