Teng Hsiang Wei

Median nerve fascicle transfer versus ULNAR nerve fascicle transfer to the biceps motor branch in C5-C6 and C5-C7 brachial plexus injuries: Nonrandomized prospective study of 23 consecutive patients

The purpose of this study was to observe whether the results of the median nerve fascicle transfer to the biceps are equivalent to the classical ulnar nerve fascicle transfer, in terms of elbow flexion strength and donor nerve morbidity. Twenty‐five consecutive patients were operated between March 2007 and July 2013. The patients were divided into two groups. In Group 1 (n = 8), the patients received an ulnar nerve fascicle transfer to the biceps motor branch. In Group 2 (n = 15), the patients received a median nerve fascicle transfer to the biceps motor branch. Two patients with follow‐up less than six months were excluded. Both groups were similar regarding age (P = 0.070), interval of injury (P = 0.185), and follow‐up period (P = 0.477). Elbow flexion against gravity was achieved in 7 of 8 (87.5%) patients in Group 1, versus 14 of 15 (93.3%) patients in Group 2 (P = 1.000). The level of injury (C5‐C6 or C5‐C7) did not affect anti‐gravity elbow flexion recovery in both the groups (P = 1.000). It was concluded that the median nerve fascicle transfer to the biceps is as good as the ulnar nerve fascicle transfer, even in C5‐C7 injuries.

Intercostal nerve transfer to the biceps motor branch in complete traumatic brachial plexus injuries

The purpose of this report is to critically evaluate our results of two intercostal nerve transfers directly to the biceps motor branch in complete traumatic brachial plexus injuries. From January 2007 to November 2012, 19 patients were submitted to this type of surgery, but only 15 of them had a follow‐up for ≥2 years and were included in this report. The mean interval from trauma to surgery was 6.88 months (ranging from 3 to 9 months). Two intercostals nerves were dissected and transferred directly to the biceps motor branch. The mean follow‐up was 38.06 months (ranging from 24 to 62 months). Ten patients (66.6%) recovered an elbow flexion strength ≥M3. Four of them (26.66%) recovered a stronger elbow flexion ≥M4. One patient (6.25%) recovered an M2 elbow flexion and four patients (26.66%) did not regain any movement. We concluded that two intercostal nerve transfers to the biceps motor branch is a procedure with moderate results regarding elbow flexion recovery, but it is still one of the few options available in complete brachial plexus injuries, especially in five roots avulsion scenario.

Cobertura do terço distal da perna com retalhos de perfurantes pediculados

SUMMARY Perforating vessels patches represent an advancement in terms of skin failures treatment. On the distal third of the leg, the alterna- tives for skin covering are scarce, often requiring microsurgery. In this study, we aimed to make a prospective assessment of 20 patients submitted to treatment of bloody areas of legs distal third by means of pedicled patches in perforating arteries. The location of the perforating arteries was preoperatively found using the eco- doppler test. The patches were planned to allow up to 180-degree rotation in the bloody area. In 6 cases, perforating vessels had the fibular artery as source; in 10, the posterior tibial artery, and; in 4, the anterior tibial artery. The accuracy rate of the ecodoppler was 88.2%. For young patients presenting injuries caused by trauma, procedure failures were found in 15.4%, and for those with associ- ated comorbidities, 33.3%. Based on our studies, we conclude that perforating vessels patches are a good alternative for skin failures on the distal segment of the leg.

Emprego do músculo gastrocnêmio no tratamento das lesões infectadas do joelho

OBJECTIVE: to prospectively evaluate the use of gastrocnemius muscle flap in the treatment of knee infected injuries. METHODS: twelve patients were operated on: eleven males with ages ranging from 19 to 78 years, mean: 55 years. Coverage of injuries with medial gastrocnemius muscle was accomplished in 11 patients and a lateral in 1. The mean number of preoperative surgical debridement procedures was 3.2, ranging from 1 to 9. RESULTS: all flaps survived. The most common etiological agent was S. aureus, in 54.5%. After a mean follow-up of 20.08 months (13 to 31), all patients show stable coverage without recurrence of infection signs or symptoms. CONCLUSION: gastrocnemius muscle use in knee infected injuries treatment presented good results and low morbity rates.

A reinforcement of the sutured microvascular anastomosis with fibrin glue application: A retrospective comparative study with the standard conventional technique

Although a reasonable number of studies report satisfactory results with fibrin glue application in microvascular anastomosis since 1977, its utilization in the clinical setting has being scant in the literature. The aim of this study was to report the cumulated experience with the fibrin glue in free flaps over a period of 10 years, comparing the survival rate with the standard sutured anastomosis.

Reimplantes nas amputações por mecanismo de avulsão: táticas e técnicas para o sucesso

OBJETIVOS: Avaliacao retrospectiva criteriosa de casos de reimplantes apos amputacao por avulsao. Avaliacao de tecnicas e taticas utilizadas que determinaram evolucao satisfatoria e bom resultado funcional. METODOS: Foram avaliados, retrospectivamente, prontuarios de 43 pacientes que tiveram membros amputados por mecanismo de avulsao e reimplantados nos ultimos 21 anos. RESULTADOS: A maior parte dos casos envolvia homens adultos jovens. A localizacao de amputacao mais frequente foi do polegar. As tecnicas e taticas cirurgicas utilizadas isoladas ou conjuntamente incluem: enxertos de nervo, enxertos vasculares (veia ou arteria), transposicao de feixe vascular digital, encurtamento do membro e reimplante heterotopico. A tecnica mais frequentemente utilizada foi o emprego de enxertos venosos. A taxa de sobrevida dos reimplantes foi alta (93%), assim como a satisfacao dos pacientes. CONCLUSAO: Os reimplantes por mecanismo de avulsao dependem do correto diagnostico de viabilidade anatomica e utilizacao de tecnicas e taticas cirurgicas apropriadas para cada caso. A experiencia da equipe cirurgica e estrutura hospitalar adequada sao fundamentais para obtencao de bons resultados. Existem poucos relatos na literatura sobre indicacao, tatica, tecnicas e resultados de procedimentos de reimplantes em amputacoes por avulsao. Acreditamos que a avaliacao retrospectiva desta serie de casos possa trazer novas informacoes e contribuicoes no atendimento desta situacao de alta complexidade. Nivel de evidencia IV, Serie de casos.

Late reconstruction of a traumatized hand with loss of multiple fingers

Mutilating hand injuries are a challenge to both the hand surgeon and the patient. The surgeon must make decisions ranging from the initial debridement to which fingers and joints will be preserved and the appropriate use of the parts to be removed. Late reconstruction constitutes the second part of this difficult task. The difficulty attributed to the characteristics of each lesion, the large number of treatment possibilities, and the different levels of complexity must be adapted to the personal needs and motivation of each patient. This case report describes a late hand reconstruction with index and middle finger loss, using metacarpophalangeal joint transplantation of the index finger to gain the proximal interphalangeal function of the middle finger. ■ ABSTRACT

Which Nerve to Use? Comparison Between Donor Nerves to Motorize the Free Functional Gracilis Muscle Transfer for Elbow Flexion in Traumatic Brachial Plexus Injuries

Introduction: Elbow flexion deficit is a frequent problem in traumatic brachial plexus injuries and reestablishment of this function is the primary treatment goal. When management is delayed or the initial acute approach fails, free functional transfer of the gracilis muscle for elbow flexion is the treatment of choice: the authors seek to determine which donor nerve (spinal accessory, intercostal, median, or ulnar) results in better elbow flexion after microsurgical reconstruction. Methods: Retrospective analysis of patients with traumatic brachial plexus injuries who underwent functional free gracilis muscle flap for elbow flexion between February 2003 and October 2014 was carried out. Postoperative function of the gracilis functional flap was recorded and patients were divided into 4 groups according to donor nerve: spinal accessory nerve (SAN), intercostal nerves (ICN), motor fascicles of the median (MED), and ulnar nerve (ULNAR). Cases in which a primary neurorrhaphy was not possible were further subdivided into 2 groups: SAN with graft interposition (SAN graft) and ICN with graft interposition (ICN graft). The final elbow flexion strength was evaluated by the British Medical Research Council (BMRC) scale and time in months when the authors first observed M3 muscle power was also of note. Results: Fifty-nine patients met inclusion criteria for this retrospective study. Two cases were excluded due to flap loss (3%) and 3 were lost to follow up (5%). Of the 54 patients enrolled, 53 were males (98.2%) with a mean age of 29 years. The mean follow-up period was 28 months. Thirty-four cases obtained muscle strength of ≥ M3 (62.9%), 6 M0 (11.1%), 4 M1 (7.5%), 10 M2 (18.5%), 13 M3 (24%), and 21 M4 (38.9%). The mean interval to first recorded M3 muscular strength was 16 months. Patients stratified by donor nerve achieving ≥ M3 had the following distribution: SAN 83.3% (15/18), SAN graft 50% (2/4), ICN 50% (2/4), ICN graft 33.3% (1/3), MED 40% (2/5), and ULNAR 60% (12/20). No statistical difference for final muscle strength was found between donor nerve groups. SAN transfer with graft interposition took longer to reach muscle strength of M3 or greater (P < .05). Conclusion: Free functional gracilis muscle flap for traumatic brachial plexus injuries is a viable option for elbow flexion recovery. Comparison between 4 different nerve transfers—SAN, ICN, MED, and ULNAR—did not clearly indicate a better alternative over the others.

COMPARATIVE STUDY OF MICROANASTOMOSIS WITH DISTINCT 10-0 NYLON SUTURES IN RATS

ABSTRACT Objective: The aim of this study is to compare micro-sutures commonly used in our midst. Methods: In this double-blind study, 30 Wistar rats were operated randomly divided into three groups matched according to the suture used (Nylon 10-0, 75micron, brands Microsuture(r), Polysuture(r) and Ethicon(r)). We analyzed the number of surgical nodes required, bleeding, surgical time and histological evaluation. Results: There was no significant difference between the amount of stitches of arterial suture per anastomosis. Surgical time was longer in Microsuture(r) group as compared to Polysuture(r) (p ≤ 0.05). Bleeding in Microsuture(r) group was higher when compared to the others (p <0.01). In the histological analysis, the Microsuture(r) group showed a greater tendency to develop fibrosis and aneurysm in surgical site than the others (p <0.01 and p≤0,05, respectively). Similarly, the Ethicon(r) group showed less tendency to myointimal proliferation than the rest. (p = 0.025). Conclusion: The results confirm the relevance of the choice of surgical thread as an independent determining factor for the success of the procedure, besides serving as a rational subsidy for a better cost-benefit analysis. Level of Evidence I, Experimental Study, Controlled Animal Study.

Biomechanical comparison of the four-strand cruciate and Strickland techniques in animal tendons

OBJECTIVE: The objective of this study was to compare two four-strand techniques: the traditional Strickland and cruciate techniques. METHODS: Thirty-eight Achilles tendons were removed from 19 rabbits and were assigned to two groups based on suture technique (Group 1, Strickland suture; Group 2, cruciate repair). The sutured tendons were subjected to constant progressive distraction using a universal testing machine (Kratos®). Based on data from the instrument, which were synchronized with the visualized gap at the suture site and at the time of suture rupture, the following data were obtained: maximum load to rupture, maximum deformation or gap, time elapsed until failure, and stiffness. RESULTS: In the statistical analysis, the data were parametric and unpaired, and by Kolmogorov-Smirnov test, the sample distribution was normal. By Students t-test, there was no significant difference in any of the data: the cruciate repair sutures had slightly better mean stiffness, and the Strickland sutures had longer time-elapsed suture ruptures and higher average maximum deformation. CONCLUSIONS: The cruciate and Strickland techniques for flexor tendon sutures have similar mechanical characteristics in vitro.