Journal of reconstructive microsurgery
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J Reconstr Microsurg · Aug 2007
Case Reports Comparative StudyLong-term results of spinal accessory nerve transfer to the suprascapular nerve in upper-type paralysis of brachial plexus injury.
In the management of upper type of brachial plexus injury, reconstruction to restore shoulder function is accomplished by multiple nerve transfers. We used the accessory nerve to neurotize the suprascapular nerve in 12 patients (11 men, 1 woman) from 1989 to 2003. The average age at the time of operation was 28.1 years (range 16 to 53). ⋯ However, average shoulder external rotation was only 16.7 degrees. We compared the shoulder flexion and abduction in patients with or without paralysis of the serratus anterior muscle and found significantly better functional outcome in the latter group of patients. We, therefore, conclude that repair of long thoracic nerve is mandatory for achieving optimum shoulder function.
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J Reconstr Microsurg · Jul 2007
Pregabalin does not impact peripheral nerve regeneration after crush injury.
Timely repair and robust regeneration after traumatic peripheral nerve injury are essential to ensure optimal recovery. Pregabalin (Lyrica; Pfizer Inc., Morris Plains, NJ), frequently prescribed to attenuate neuropathic pain in patients with traumatic nerve injury, was evaluated for its potential to alter nerve regeneration in the rat sciatic crush model. ⋯ There were no significant differences in sciatic function index or histomorphometric parameters at the 21-day endpoint between the pregabalin-treated rats undergoing crush injury and the saline-treated controls. Although we have observed a subjectively improved clinical course in human patients treated with pregabalin after traumatic nerve injury, the effect does not appear to be due to accelerated nerve regeneration.
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J Reconstr Microsurg · May 2007
Microsurgical reconstruction for radiation necrosis: an evolving disease.
We performed a retrospective chart review of a tertiary care medical center. Our objective was to report our experience with microvascular reconstruction in the head and neck in patients who presented with radiation-induced tissue damage. We will discuss the effects of radiation to soft tissues and bone in the head and neck as well as the challenges it presents for later free tissue transfer. ⋯ As primary treatment for head and neck cancer moves toward radiation therapy, microsurgical reconstruction is playing an increasing role for those patients developing radiation-related complications. Radionecrosis is a progressive disease where the incidence is increasing as patients are surviving longer. Understanding the effects of radiation on soft tissue and bone and the complexity of reconstruction in the zone of injury will greatly improve the success of reconstruction.
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J Reconstr Microsurg · Nov 2006
Comparative StudyPosterior-wall-first continuous suturing combined with conventional interrupted suturing for microvascular anastomosis.
Vascular anastomosis with conventional interrupted suturing is often difficult to perform when the vascular clamp is not reversed, because of a narrow operative field or a short vascular pedicle. A posterior-wall-first continuous suture technique combined with the standard interrupted suture technique is one method of solving this problem. ⋯ Electron microscopy demonstrated no significant difference in recoverability of the intima. The posterior-wall-first continuous suture technique combined with the standard interrupted suture technique is a useful alternative to the conventional interrupted suture technique.
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J Reconstr Microsurg · Oct 2006
Free inferior gluteal flap harvest with sparing of the posterior femoral cutaneous nerve.
The free inferior gluteal flap is a major secondary choice of autologous tissue for breast reconstruction if the TRAM flap is not an option. Loss of posterior thigh and popliteal sensibility is a frequent sequela of harvesting the free inferior gluteal musculocutaneous flap and the inferior gluteal artery perforator (I-GAP) flap. The posterior femoral cutaneous nerve of the thigh lies directly on the deep surface of the gluteus maximus muscle, having a very close anatomic relationship with the inferior gluteal artery. ⋯ In 94.5 percent of the pelvic halve dissections, it was possible to maintain at least a portion of the PFCN intact after isolation of the inferior gluteal artery pedicle while harvesting the free inferior gluteal myocutaneous flap. These findings support a nerve-sparing approach to inferior gluteal myocutaneous flap elevation to minimize the sequela of posterior thigh anesthesia. These data also emphasize the intimate relationship of the PFCN and the gluteal artery and the real possibility of injury to the PFCN during I-GAP harvest.