Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Mar 2013
Comparative StudyTransversus abdominis plane (TAP) catheters inserted under direct vision in the donor site following free DIEP and MS-TRAM breast reconstruction: a prospective cohort study of 45 patients.
The transversus abdominis plane (TAP) block is a peripheral nerve block of T6-L1 intercostal nerves of the abdominal wall. The purpose of this study was to evaluate the usefulness of intermittent TAP blockade for the first two postoperative days following free muscle sparing-transverse rectus abdominis muscle (MS-TRAM) or deep inferior epigastric perforator (DIEP) flap reconstruction of the breast. Therapeutic--Level II evidence. ⋯ Intermittent delivery of bupivacaine through the TAP block significantly reduced postoperative parenteral opioid requirements following free MS-TRAM or DIEP flap reconstruction of the breast. This is the first report of the TAP block being inserted under direct vision to provide postoperative analgesia at the abdominal flap donor site following microsurgical breast reconstruction.
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J Plast Reconstr Aesthet Surg · Mar 2013
Case ReportsDouble nerve transfer for elbow flexion in obstetric brachial plexus injury: a case report.
We report a case of a 10-month-old boy with a left extended upper type (C5-C7) obstetric brachial plexus injury that was treated with double nerve transfer (partial ulnar and partial median nerve transfer) to restore elbow flexion and spinal accessory nerve transfer to the suprascapular nerve to restore shoulder abduction. At 60 months' follow-up, shoulder abduction was 0-150° (M4) and elbow flexion was 0-140° (M5). Elbow, wrist and finger extension improved to M5. ⋯ No weakness on finger and wrist flexion was observed. Double nerve transfers to restore elbow flexion can be safely done in obstetric brachial plexus injuries with good results. Secondary surgeries may be needed to improve external rotation.