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Hand surgery ; microsurgery ; brachial plexus

Christian T Bonde, Lisa Toft Jensen, Tina Tos, Birgitte Jul Kiil, Gete Ester Toft, Søren Erik Larsen, Peter Birkeland, Jens Ahm Sørensen
Microsurgery is defined as surgery performed with the aid of ocular magnification. In Denmark, this is undertaken by four units. This review describes the history of microsurgery which evolved during the 1960s. Microsurgery in hand surgery is primarily replantation and revascularisation but also peripheral nerve surgery as well as brachial plexus surgery. Lymphoedema is being treated with super microsurgery on an experimental basis. Dynamic reconstruction of facial palsy is performed in a two-stage operation with cross-over nerve graft and a free microvascular muscle flap, typically gracilis...
June 6, 2016: Ugeskrift for Laeger
Tarek A El-Gammal, Amr El-Sayed, Mohamed M Kotb, Waleed Riad Saleh, Yasser Farouk Ragheb, Omar Refai, Mohamed Mohamed Morsy
BACKGROUND: In late obstetric brachial plexus palsy (OBPP), restoration of elbow and hand functions is a difficult challenge. The use of free functioning muscle transplantation in late OBPP was very scarcely reported. In this study, we present our experience on the use of free functioning gracilis transfer for restoration of elbow and hand functions in late cases of OBPP. PATIENTS AND METHODS: Eighteen patients with late OBPP underwent free gracilis transfer for reconstruction of elbow and/or hand functions...
July 2015: Microsurgery
Rao Fu, Ying Tang, Ze-Min Ling, Ying-Qin Li, Xiao Cheng, Fa-Huan Song, Li-Hua Zhou, Wutian Wu
BACKGROUND: During the clinical treatment of the brachial plexus root avulsion (BPRA), reimplantation surgery can not completely repair the motor function of the hand because the axonal growth velocity of the spinal motoneurons (MNs) is too slow to re-innervate the intrinsic hand muscles before muscle atrophy. Here, we investigated whether lithium can enhance the regenerative capacity of the spinal MNs in a rat model of BPRA. RESULTS: The avulsion and immediate reimplantation of the C7 and C8 ventral roots were performed and followed with daily intraperitoneal administration of a therapeutic concentrationof LiCl...
2014: BMC Neuroscience
M C Romaña, A Rogier
Obstetrical brachial plexus palsy is considered to be the result of a trauma during the delivery, even if there remains some controversy surrounding the causes. Although most babies recover spontaneously in the first 3 months of life, a small number remains with poor recovery which requires surgical brachial plexus exploration. Surgical indications depend on the type of lesion (producing total or partial palsy) and particularly the nonrecovery of biceps function by the age of 3 months. In a global palsy, microsurgery will be mandatory and the strategy for restoration will focus first on hand reinnervation and secondarily on providing elbow flexion and shoulder stability...
2013: Handbook of Clinical Neurology
S Kakar, K Bakri, A Y Shin
PURPOSE: To survey practicing hand surgeons regarding their perceived need for an expanded upper extremity fellowship. METHODS: Electronic surveys were sent to 248 surgeons who had completed a hand surgery fellowship between 2008 and 2010. The survey was structured to ascertain whether there was a need for expanded education encompassing the entire upper extremity. Four separate mailings were made. Of the 248 surgeons who were sent the survey, 131 (53%) responded...
November 2012: Journal of Hand Surgery
T L Schenck, T Bayer, A Enders, M-A Marton, H-G Machens, W Müller-Felber, R E Giunta
Most cases of obstetrical brachial plexus palsies are mild traction injuries which resolve under physical therapy within several weeks or months. Severe ruptures or avulsion injuries of the plexus can lead to lifelong impairment of the upper extremities. Hence, in severe brachial plexus injuries the indications for brachial plexus reconstruction should be evaluated, early. At the age of about 3 months, the infant should be presented in a centre specialised in obstetrical brachial plexus palsies. In almost all cases intensive physical therapy is performed...
April 2011: Handchirurgie, Mikrochirurgie, Plastische Chirurgie
Gonzalo Bonilla, Gilda Di Masi, Danilo Battaglia, José María Otero, Mariano Socolovsky
BACKGROUND: Peripheral nerve lesions usually are associated with neuropathic pain. In the present paper, we describe a simple scale to quantify pain after brachial plexus injuries and apply this scale to a series of patients to determine initial outcomes after reconstructive surgery. METHODS: Fifty-one patients with traumatic brachial plexus avulsion injuries were treated over the period of one calendar year at one center by the same surgical team. Of these, 28 patients who were available for follow-up reported some degree of neuropathic pain radiating towards the hand or forearm and underwent reconstructive microsurgery and direct pain management, including trunk and nerve neurolysis and repair...
January 2011: Acta Neurochirurgica
Tarek A El-Gammal, Amr El-Sayed, Mohamed M Kotb, Yasser Farouk Ragheb, Waleed Riad Saleh, Ramy Mohamed Elnakeeb, Ahmad El-Sayed Semaya
From 2000 to 2006, 35 infants with total obstetric brachial plexus palsy underwent brachial plexus exploration and reconstruction. The mean age at surgery was 10.8 months (range 3-60 months), and the median age was 8 months. All infants were followed for at least 2.5 years (range 2.5-7.3 years) with an average follow-up of 4.2 years. Assessment was performed using the Toronto Active Movement scale. Surgical procedures included neurolysis, neuroma excision and interposition nerve grafting and neurotization, using spinal accessory nerve, intercostals and contralateral C7 root...
2010: Microsurgery
Jayme Augusto Bertelli, Marcos Flávio Ghizoni
PURPOSE: Vascularized nerve grafts are indicated for the repair of large nerve defects. In brachial plexus injuries, the poor prognosis for functional hand reconstruction when the lower roots are avulsed makes the ulnar nerve a potential donor for vascularized nerve grafts. We report on the results we obtained with reconstruction of elbow flexion using long pedicled ulnar nerve grafts that connected the C5 root to the musculocutaneous nerve. METHODS: We prospectively studied 8 young adults with complete brachial plexus palsy with avulsion of the lower roots, who had surgical repair an average of 4...
December 2009: Journal of Hand Surgery
P MacNamara, A Yam, M D Horwitz
We retrospectively studied the possibility that direct trauma to the biceps muscle might be the cause of poor elbow flexion and supination in 18 consecutive children with birth lesions of the brachial plexus who had delayed or impaired biceps recovery despite neurophysiological evidence of reinnervation. All had good shoulder and hand function at three months of age. Eight recovered a strong biceps after six months, but nine required a pectoralis minor to biceps transfer to augment elbow flexion and supination...
August 2009: Journal of Bone and Joint Surgery. British Volume
Julia K Terzis, Zinon T Kokkalis
BACKGROUND: In children with global obstetric brachial plexus palsy, prioritization should be first focused on hand reinnervation and then directed to shoulder and elbow function. In this study, the surgical strategy for restoration of hand function and the methods and outcomes are analyzed. METHODS: Between 1979 and 2005, 59 patients (61 extremities) underwent reconstruction for hand reanimation. The mean follow-up was 7.7 years (range, 2 to 22 years). Of these, 16 cases underwent primary reconstruction alone, 35 underwent both primary and secondary procedures, and 10 late cases underwent palliative surgery...
August 2008: Plastic and Reconstructive Surgery
Marios D Vekris, Marios G Lykissas, Alexandros E Beris, Grigorios Manoudis, Anastasios D Vekris, Panayiotis N Soucacos
Birth brachial plexus injury usually affects the upper roots. In most cases, spontaneous reinnervation occurs in a variable degree. This aberrant reinnervation leaves characteristic deformities of the shoulder, elbow, forearm, wrist, and hand. Common sequelae are the internal rotation and adduction deformity of the shoulder, elbow flexion contractures, forearm supination deformity, and lack of wrist extension and finger flexion. Nowadays, the strategy in the management of obstetrical brachial plexus palsy focuses in close follow-up of the baby up to 3-6 months and if there are no signs of recovery, microsurgical repair is indicated...
2008: Microsurgery
M Kirjavainen, V Remes, J Peltonen, S Rautakorpi, I Helenius, Y Nietosvaara
Hand function was evaluated in 105 patients who had been operated on in early infancy for brachial plexus birth palsy. The mean follow-up after surgery was for 13.4 years (5.0 to 31.5). Fine sensation, stereognosis, grip and pinch strength and the Raimondi scale were recorded. Fine sensation was normal in 34 of 49 patients (69%) with C5-6 injury, 15 of 31 (48%) with C5-7 and in 8 of 25 (32%) with total injury. Loss of protective sensation or absent sensation was noted in some palmar areas of the hand in 12 of 105 patients (11%)...
March 2008: Journal of Bone and Joint Surgery. British Volume
S Rochkind, M Shemesh, H Patish, M Graif, Y Segev, K Salame, E Shifrin, M Alon
BACKGROUND: Thoracic outlet syndrome (TOS) refers to a group of complex symptoms in the upper extremity caused by compression of the brachial plexus, subclavian artery and vein. Different surgical approaches were described for the management of TOS. There is, however, no "gold standard" procedure for this complicated and multidisciplinary problem. OBJECTIVES: This study evaluated the effectiveness of a microsurgical neurovascular decompression in the treatment of TOS...
2007: Acta Neurochirurgica. Supplement
Han-Hsiang Su, Ping-Wing Lui, Chi-Lun Yu, Chin-San Liew, Chih-Hung Lin, Yu-Te Lin, Chia-Hung Chang, Min-Wen Yang
BACKGROUND: Continuous axillary brachial plexus block with local anesthetic has been shown to improve tissue perfusion after replantation surgery of the extremity. The present study aimed to investigate whether continuous axillary brachial plexus block with ropivacaine infusion can improve the survival of the reconstructive fingers secondary to an increase in its skin temperature in patients receiving replantation surgery of the crushed fingers. METHODS: Under general anesthesia, 18 patients received replantation or toe-to-hand transplantation of their crushed digits...
August 2005: Chang Gung Medical Journal
Ercan Kurt, Serdar Ozturk, Selcuk Isik, Fatih Zor
Microsurgical operations of the hand are common procedures of reconstructive surgeons. Sympathetic blockade of the vessels provides increased blood flow to the injured extremity, which increases the success rate of the surgery. Moreover, postoperative pain management can be performed with continuous blockade of the nerves. In this article, the effect of continuous brachial plexus blockade on patients who underwent upper extremity microsurgical operation was evaluated.A total of 16 patients were operated on either for replantation or for toe-to-hand transfer...
January 2005: Annals of Plastic Surgery
Nicholas C Smith, Peter Rowan, Laurel J Benson, Marybeth Ezaki, Peter R Carter
BACKGROUND: An important prognostic factor in neonatal brachial plexus palsy is the time interval to biceps muscle recovery. Although the natural history is not clear, biceps muscle recovery after more than three months of age has been used to predict poor long-term shoulder function. The absence of biceps muscle function at three months of age has been adopted as an indication for early brachial plexus microsurgery, in an attempt to improve recovery. To provide a benchmark for outcome comparison, the long-term outcome of patients with absent biceps muscle function at three months of age was studied...
October 2004: Journal of Bone and Joint Surgery. American Volume
G Antoniadis, R W König, K Mohr, T Kretschmer, H-P Richter
Obstetrical brachial plexus palsy occurs at a frequency of 0.6 to 2.5 per 1000 births. 80 to 95% of these lesions recover spontaneously. If spontaneous recovery does not occur within the first six months of life, investigations like electrophysiology, and CT-myelography and surgical exploration of the brachial plexus are recommended. During the last ten years 73 children with obstetrical brachial plexus lesions were examined in our department. 29 newborns underwent surgery on the brachial plexus. In 20 out of 29 children nerve root avulsions were diagnosed preoperatively...
March 2003: Handchirurgie, Mikrochirurgie, Plastische Chirurgie
S Wang
No abstract text is available yet for this article.
October 1999: Chinese Medical Journal
P C Amadio
No abstract text is available yet for this article.
March 2001: Journal of Bone and Joint Surgery. American Volume
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