Oxford Reconstructive Plastic Hand Innovation Collaboration, Oxford University Hospitals NHS Foundation Trust, United Kingdom; Department of Plastic, Reconstructive and Hand Surgery, Oxford University Hospitals NHS Foundation Trust, United Kingdom; Nuffield Department of Surgical Sciences, Oxford University Hospitals NHS Foundation Trust, United Kingdom.
Mater Misericordiae University Hospital, Dublin, Ireland.
J Hand Surg Am. 2021 Feb;46(2):147.e1-147.e8. doi: 10.1016/j.jhsa.2020.07.021. Epub 2020 Sep 30.
Reanimation of palsied upper limbs usually follows an escalating pattern of nerve repair, nerve transfers, and musculotendinous transfers and culminates in free functioning muscle transfers. When there are no other musculotendinous options, we explored the possibility of transferring the rectus abdominus to the biceps by maintaining the nerve pedicle but dividing the vascular pedicle and anastomosing it to the brachial artery.
We performed anatomical dissection of the nerve and blood supply of 6 rectus abdominis muscles in 3 cadavers. A retrospective analysis of 4 patients in whom a rectus abdominus muscle transfer with a pedicled nerve, but free vascular supply, was then performed.
The anatomical feasibility study demonstrated that it was possible to elevate the rectus abdominis on its intercostal nerve supply to the midaxillary line, allowing the muscle to be pedicled on its nerve supply and be transferred to the arm to reconstruct biceps. The vascular supply could be reestablished by anastomosis of inferior epigastric vessels to the brachial artery and veins. In 4 patients, elbow flexion strength of M3 or greater was achieved. Average elbow range of dynamic flexion was 120° (range, 92° to 131°). Shoulder stability and external rotation improved in all patients with resolution of shoulder subluxation. Two patients developed donor site hernias requiring mesh reconstruction. Complications included a hypertrophic recipient site scar in one patient, and recipient site wound dehiscence in another.
Rectus abdominus can be transferred to reconstruct elbow flexion when other musculotendinous transfers are unavailable and as an alternative to free functioning muscle transfer. However, rectus abdominus transfer still requires microsurgical skills for the vessel anastomoses. This is an effective procedure for functional reconstruction of the elbow and adds to the armamentarium in the management of brachial plexus pathology when other transfers are unavailable.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
瘫痪上肢的再活动通常遵循神经修复、神经转移和肌肉肌腱转移的递增模式，最终达到自由功能肌肉转移。当没有其他肌肉肌腱选择时，我们通过保留神经蒂但分割血管蒂并将其吻合到肱动脉，探索将腹直肌转移到肱二头肌的可能性。
我们在 3 具尸体上对 6 块腹直肌的神经和血液供应进行了解剖学解剖。然后对 4 例接受带蒂神经但自由血管供应的腹直肌转移的患者进行回顾性分析。
解剖可行性研究表明，有可能通过肋间神经提起腹直肌到腋中线，允许肌肉在其神经蒂上转移到手臂以重建肱二头肌。可以通过将腹壁下血管吻合到肱动脉和静脉来重建血管供应。在 4 例患者中，实现了 M3 或更大的肘部屈曲力量。平均动态屈曲肘部范围为 120°（范围，92°至 131°）。所有患者的肩稳定性和外旋均改善，肩部半脱位得到解决。2 例患者发生供体部位疝，需要网片重建。并发症包括 1 例患者的受体部位肥厚性瘢痕和另 1 例患者的受体部位伤口裂开。
当其他肌肉肌腱转移不可用时，腹直肌可以转移来重建肘部屈曲，并且是自由功能肌肉转移的替代方法。然而，腹直肌转移仍然需要血管吻合的显微外科技能。当其他转移不可用时，这是一种有效的肘部功能重建方法，为臂丛神经病变的治疗提供了更多选择。
研究类型/证据水平：治疗性 V 级。
