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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

The role of free vascularized and innervated muscle transfer in functional reconstruction after irreparable brachial plexus lesions

Die Rolle des freie vaskularisierten und innervierten Muskellappens in der funktionelle Rekonstruktion des Armes bei irrreparablen Plexus brachialis Lähmungen

Meeting Abstract

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  • corresponding author K.G. Krishnan - Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden
  • K. D. Martin - Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden
  • G. Schackert - Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocDI.05.06

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc180.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Krishnan et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: After severe brachial plexus injuries, certain neural elements always remain irreparable. Free vascularized and innervated muscle transfer (FFMT) to the upper extremity (UE) is one of the final choices for its functional reconstruction. FIMT to the UE may be classified into three categories: (a) Type I – from a condyle to tendons; (b) Type II – across one joint (c) Type III – across two joints. We attempt to analyze the results after FIMT in UE-reconstruction.

Methods: We use the gracilis muscle routinely as FFMT. 23 patients (all males; 12 – 62 years) underwent transfer of gracilis for UE reanimation (Type I – 11 patients; Type II – 8 patients; Type III – 4 patients). The indications were (a) chronic irreparable nerve lesions, (b) acute injuries with soft tissue and nerve loss and, more importantly (c) non availability of simpler methods of functional reanimation. The mean follow-up was 3 years (8 months to 5 years).

Results: Muscle strength of M4 or M+ could be achieved only in acute reconstruction with soft tissue loss and in children. Usual muscle strength at a mean follow-up period of 1.5 years is not above M3. Tendinous contracture, requiring secondary release, is a common phenomenon after FFMT.

Conclusions: FFMT is one of the final options for functional UE reconstruction, especially after severe brachial plexus injuries. It should be implemented only when other, simpler methods are not provided. Both physician and patient should have realistic expectations after FFMT. Regardless of these pitfalls, FFMT is one of the possible methods to achieve function in a flail UE.