Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil.
Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil.
Orthop Traumatol Surg Res. 2021 Apr;107(2):102827. doi: 10.1016/j.otsr.2021.102827. Epub 2021 Jan 28.
The traumatic lesions of the brachial plexus in adults are devastating injuries causing continuous severe functional impairment for both work and daily living activities. The restoration of elbow flexion is one of the most important movements for patient recovery to previous activities. Free gracilis muscle transfer has good outcomes for cases with late presentation or as a rescue surgery to regain elbow flexion, however, bad results are present in all cohorts with insufficient recovery of muscle strength for elbow flexion. A number of hypotheses can be postulate to explain the fair results observed in some cases of free gracilis muscle transfer for elbow flexion. Most studies in the current literature compare the choice of the donor nerve used in neurotization and nerve grafts. The aim of this study is to evaluate if technical components of microvascular anastomosis could influence the functional outcome of free functional muscle transfer for elbow flexion in adult patients with traumatic brachial plexus injury.
Included all adult patients with traumatic brachial plexus injury submitted to free functional gracilis muscle transfer for elbow flexion. The complications and functional results according to British Medical Research Council (BMRC) score were recorded.
We assessed 26 patients with mean age of 32.8 years. The most common donor nerve for gracilis muscle was the accessory nerve in 18 patients. Eighteen patients presented with good result (M3/M4). The mean ischemia time was higher for patients with bad results (132 minutes) comparing with patients with good results (122 minutes). Patients with only one venous anastomosis had 41% of poor functional outcome compared with 22% of cases with two venous anastomoses. No statistically significant difference in the ischemia time of the cases with good or poor functional outcome was observed (p=0.657), as for the number of venous anastomoses (p=0.418).
Our study observes that patients with only one venous anastomoses for drainage of free gracilis and those with longer intraoperative ischemia time had higher incidence of poor functional outcome of free gracilis muscle transfer for elbow flexion, but not statistically significant.
II; prospective cross-sectional study.
成人臂丛外伤性损伤是毁灭性的损伤，会持续严重影响工作和日常生活活动的功能。恢复肘部弯曲是患者恢复先前活动最重要的运动之一。游离股薄肌移植对于晚期表现或恢复肘部弯曲的抢救手术来说，效果良好，但对于所有因肘部弯曲肌力恢复不足而导致效果不佳的患者，效果都不理想。有许多假说可以解释游离股薄肌移植治疗肘部弯曲的效果。目前文献中的大多数研究都比较了神经化和神经移植中使用的供体神经的选择。本研究旨在评估微血管吻合的技术因素是否会影响外伤性臂丛损伤成年患者游离功能性股薄肌移植治疗肘部弯曲的功能结果。
纳入所有接受游离功能性股薄肌移植治疗肘部弯曲的外伤性臂丛损伤成年患者。记录并发症和根据英国医学研究理事会（BMRC）评分的功能结果。
我们评估了 26 名平均年龄为 32.8 岁的患者。18 名患者使用副神经作为股薄肌的供体神经。18 名患者的结果良好（M3/M4）。结果较差的患者（132 分钟）的平均缺血时间高于结果较好的患者（122 分钟）。只有一条静脉吻合的患者功能结果不良的发生率为 41%，而有两条静脉吻合的患者为 22%。在功能结果良好或不良的病例中，缺血时间无统计学差异（p=0.657），静脉吻合数量也无统计学差异（p=0.418）。
我们的研究观察到，对于游离股薄肌引流只有一条静脉吻合的患者和术中缺血时间较长的患者，游离股薄肌移植治疗肘部弯曲的功能结果较差的发生率较高，但无统计学意义。
II；前瞻性的横断面研究。
