Journal of reconstructive microsurgery
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J Reconstr Microsurg · Feb 2002
Comparative StudyPre-, intra-, and postoperative electrophysiologic analysis of the recovery of old injuries of the peripheral nerve and brachial plexus after microsurgical management.
This prospective electrophysiologic study compares the analysis of the pre-, intra-, and postoperative results of 38 surgically treated patients suffering from old injuries of the peripheral nerve (n=28) and brachial plexus (n=10). The period from injury until surgery for the peripheral nerve group ranged from 1.2 to 50 years and, in the brachial plexus group, from 1.2 to 12 years. A statistical electrophysiologic analysis was done: 1) to compare intraoperative amplitude and latency changes of the compound muscle action potential (CMAP) at commencement and on completion of surgery; 2) to compare amplitude and latency changes of CMAP and recruitment (voluntary muscle activity) prior to and 1 year after surgery. ⋯ In the brachial plexus group, statistical analysis of recruitment showed voluntary muscle activity in 45 percent of muscles 1 year after neurolysis (7 patients) and in 42 percent of muscles after nerve graft and neurotization (3 patients). Intraoperative electrophysiologic findings provide useful information during surgery for old peripheral nerve and brachial plexus injury. Intraoperative and postoperative electrophysiologic analyses suggest that the viability of the old injured nerve tissue is longer than previously considered, thus providing a longer period of time in which nerve recovery can occur.
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Regional anesthesia, with its known benefits such as increased blood flow, reduced cost, and security, is a method of choice for hand surgery. Recently, the authors have switched from axillary block to continuous cervical epidural anesthesia, which has several advantages such as low cost, a pain-free postoperative period, better control of tourniquet pain, and the avoidance of a motor block so that early active motion is possible. ⋯ Postoperatively, only 4 ml/hr ultracaine (articaine 2 percent) is sufficient to provide a sensory block. The method provides both good perfusion and a lower local anesthetic drug dosage than axillary block.
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J Reconstr Microsurg · Aug 2001
Usefulness of free sensate osteofasciocutaneous forearm and fibula flaps for neophallus construction.
Female-to-male transsexuals have been treated by the authors since the 1970's, using different operative methods. Since 1981, these patients have received neophallus construction with free sensate osteofasciocutaneous forearm flaps and, since 1993, with free sensate osteofasciocutaneous fibula flaps. In order to evaluate the usefulness of these flaps, the authors performed, in 24 patients (12 with forearm and 12 with fibula flaps), the following examinations: clinical and radiologic evaluations of the neophallus and its donor site, as well as patient questionnaires. ⋯ On radiologic examination, robust, calcified bone structure, and no fracture of the neophallus bone and its donor site, as well as no instability of the ankle joint (in the fibula flap patients) were found. These findings further support the use of these free sensate osteofasciocutaneous flaps for neophallus construction. In the authors' opinion, it is the patient who must decide which method should be used for neophallus construction.
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J Reconstr Microsurg · Feb 2001
Case ReportsCorrection of scapular winging by supraclavicular neurolysis of the long thoracic nerve.
Injury to the long thoracic nerve results in winging of the scapula. When there is no known direct site of injury to this nerve, the traditional treatment consists of bracing the shoulder and, if recovery of function does not occur, then carrying out a muscle transfer to reconstitute the forces required to bring the scapula into appropriate position with respect to the thorax. The present report describes four patients in whom a site of compression of the long thoracic nerve within the scalene muscles proved to be the site of compression. A supraclavicular neurolysis of the long thoracic nerve resulted in correction of the winged scapula in all four of these patients.
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J Reconstr Microsurg · Oct 2000
Microsurgical management of old injuries of the peripheral nerve and brachial plexus.
A prospective study was carried out in patients suffering from old peripheral nerve and brachial plexus injuries to attempt to validate that functional improvement was possible after microsurgical management. Fifty patients underwent operative procedures, of whom 35 were peripheral-nerve injury cases, from 1.2 to 50 years after injury, and 15 were brachial-plexus injury cases, from 1.2 to 12 years after injury. The patients were treated by external and interfascicular neurolysis and/or autogenous nerve grafts. ⋯ Statistical analysis of recruitment 1 year after surgery demonstrated the appearance of or significant voluntary muscle activity in 45 percent of the muscles. Intraoperative electrophysiologic findings after external and interfascicular neurolysis confirmed that the viability of nerve tissue is of longer duration than previously considered. This study suggests that the use of microsurgical techniques results in the functional improvement of patients suffering from old injuries of the peripheral nerve and brachial plexus.