Treatment of Complete Brachial Plexus Injuries Using Double Free Muscle Transfer.

Autor:	Kakinoki R; Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan. Electronic address: rkakinoki@med.kindai.ac.jp., Ohtani K; Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan., Ohta S; Department of Orthopedic Surgery, Kansai Electric Power Hospital, Osaka, Japan., Ikeguchi R; Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan., Akagi M; Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan., Goto K; Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan.
Jazyk:	angličtina
Zdroj:	The Journal of hand surgery [J Hand Surg Am] 2023 Nov 02. Date of Electronic Publication: 2023 Nov 02.
DOI:	10.1016/j.jhsa.2023.09.005
Abstrakt:	Purpose: The purpose of this study was to examine the surgical outcomes of double free muscle transfer (DFMT) performed in patients with complete brachial plexus injury (BPI). Methods: We retrospectively analyzed the outcomes of DFMT for 12 patients with complete BPI who were followed up for more than 2 years after the final muscle transplantation. Their mean age was 29 years (range, 18-41). Three patients underwent contralateral C7 nerve root transfer before the DFMT. The range of motion (ROM) of the shoulder, elbow, and fingers was measured. Patient-reported outcome measures, including Disability of the Shoulder, Arm, and Hand (DASH) scores and visual analog scale (VAS) scores for pain, were also examined. Results: The mean shoulder ROM against gravity was 22° ± 8° in abduction and 33° ± 5° in flexion. Seven patients underwent phrenic nerve (PhN) transfer to the suprascapular nerves, and five exhibited asymptomatic lung impairment on spirography more than 2 years after PhN transfer. The mean elbow ROM against gravity was 111° ± 9° in flexion and -32° ± 7° in extension. All patients obtained elbow flexion >90° against a 0.5-kg weight. All patients obtained touch sensation and two recognized warm and cold sensations in the affected palm. The mean total active motion of the affected fingers was 44° ± 11°. All patients exhibited hook function of the hands. The mean preoperative and postoperative DASH scores were 70.3 ± 13.4 and 51.8 ± 15.9, respectively. The mean pain VAS score was 28 ± 31 at the final follow-up. Conclusions: Double free muscle transfer provided patients with complete brachial plexus palsy with good elbow flexion and hand hook functions. Type of Study/level of Evidence: Therapeutic IV. (Copyright © 2023 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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