Yasuhiro Hiura

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.)

Relation between distal motor latency delay and sensory action potential absence of the median nerve in carpal tunnel syndrome

OBJECTIVE To elucidate the cutoff value for distal motor latency (DML) at which sensory nerve action potentials (SNAPs) are absent in carpal tunnel syndrome (CTS) patients. METHOD We examined 157 hands in 129 patients with CTS retrospectively. We classified the patients according to whether SNAPs were successfully obtained. Group A consisted of hands with SNAPs, while Group B consisted of hands without SNAPs. The cutoff value for DML was determined by receiver-operating characteristic curve analysis. We enrolled 130 hands with CTS for the analysis, because measurements were successful in 130 hands for compound muscle action potentials and in 82 hands for SNAPs from a total of 157 hands investigated. RESULTS A significant correlation was observed between DML and SCV (P<0.0001, R*2=0.40). The most discriminative cutoff value for DML was 7.7ms, resulting in a sensitivity of 79.6% and specificity of 79.3%. CONCLUSION Cases in which SNAPs are evoked despite a DML longer than 7.7ms should raise suspicion.

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。