Fujio Kawakami

Significance of elbow extension in reconstruction of prehension with reinnervated free-muscle transfer following complete brachial plexus avulsion.

&NA; Thirty‐one patients with complete avulsion of the brachial plexus underwent reconstruction of elbow extension by intercostal nerve transfer following reconstruction of prehension with either a single or double free‐muscle transfer. Long‐term results of elbow extension were evaluated in 24 patients. Reinnervation of the triceps muscle took longer than that of the transferred muscle on serial electromyographic examinations, and the eventual strength of the triceps muscle was weak. None attained M5 grade, 2 achieved M4 grade, 4 achieved M3 grade, 8 achieved M2 grade, 5 achieved M1 grade, and another 5 achieved MO grade. However, despite the weak recovery, 14 patients were able to obtain useful functional recovery of the triceps muscle, enabling it to stabilize the elbow joint against the transferred muscle, which acted as simultaneous elbow flexor and wrist or finger extensor. Elbow stability is imperative in order to obtain voluntary finger function following free‐muscle transfer. Should the triceps muscle fail to recover following intercostal nerves neurotization, transferring the reinnervated infraspinatus to the triceps is an optional procedure to provide stabilization of the elbow. (Plast. Reconstr. Surg. 100: 364, 1997.)

Limb-sparing surgery with reinnervated free-muscle transfer following radical excision of soft-tissue sarcoma in the extremity.

Limb-sparing surgery is the preferred approach in the management of patients with high-grade soft-tissue sarcomas when local disease can be completely resected. However, conventional treatment focuses only on restoration of basic functions to the remnant limb. Lost functions are not restored to normal, leaving the patient with variable degrees of functional disabilities. This in turn may necessitate further massive reconstructive procedures. Transferred reinnervated free muscles were used to reconstruct functions lost after radical resection of malignant soft-tissue sarcoma of the extremities in 17 patients. The long-term functional outcome included survival of transplanted muscle, speed of neural recovery, and muscle strength and disabilities. All muscles survived. Postoperative follow-up ranged from 27 to 106 months. All muscles except those in a 75-year-old patient were successfully reinnervated. Powerful strength and almost normal limb functions were obtained. Functional scoring of the patients according to the rating system of the Musculoskeletal Tumor Society was 87 percent for the lower extremity and 93 percent for the upper extremity. All patients are presently disease-free. Use of the reinnervated free-muscle transfer in limb-sparing surgery after resection of soft-tissue sarcoma in the extremity may be indicated in the young adult when radical excision of the tumor will result in severe motor functional loss, provided adequate clearance can be obtained and that there is no presence of distant metastasis.

THE SAUVÉ-KAPANDJI PROCEDURE IN COMBINATION WITH OPENING RADIAL WEDGE OSTEOTOMY FOR MALUNION OF DISTAL RADIUS FRACTURES

The Sauve-Kapandji procedure in combination with an opening radial wedge osteotomy for malunion of distal radius fractures was performed in six patients. Follow-up at an average of 40.3 months showed two excellent, three good, and one poor result. Satisfactory results were obtained in restoration of forearm rotation and improvement of pain in all patients. The Sauve-Kapandji procedure in addition to an opening radial wedge osteotomy was indicated when a preoperative limitation of forearm rotation with severe pain and radiographic evidence of degenerative changes in the distal radioulnar joint were present. We have found combining these two procedures to be a reliable treatment option for malunion of distal radius fractures.

Use of Medical Leech for Alleviating Postoperative Venous Congestion Following Distal Digit Replantation.

指末節部の切断指再接着術後のうっ血に対し, 医療用に開発されたヒルを使用し良好な結果を得ることができた。わずか数十分の使用で数時間にわたる出血が得られ, 従来行われていた医師もしくは看護婦によるミルキング等の処置を必要とせず, 医療サイドの負担を大きく軽減させることが可能となった。ヒルの使用による感染の危険もあるが, 第2, 3世代のセフェム系抗生剤に感受性があるため十分予防可能である。