gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

Reanimation of the flaccid shoulder using free functional muscle transplantation (FFMT) in longstanding brachial plexus lesions

Meeting Abstract

  • K.G. Krishnan - Neurochirurgische Klinik, Medizinische Hochschule Hannover
  • G. Schackert - Neurochirurgische Klinik, Carl Gustav Carus Universität Dresden
  • V. Seifert - Neurochirurgische Klinik, Johann Wolfgang Goethe Universität Frankfurt
  • J.K. Krauss - Neurochirurgische Klinik, Medizinische Hochschule Hannover

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.05.09

DOI: 10.3205/11dgnc134, URN: urn:nbn:de:0183-11dgnc1348

Veröffentlicht: 28. April 2011

© 2011 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 vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Primary reconstruction of the brachial plexus and peripheral nerves results in favourable outcomes only when performed within a given time frame, when the target muscles still have the potential to be reinnervated. In long standing lesions, secondary reanimation surgery has come to play an important role. The FFMT for flaccid brachial plexus lesions was described first by Doi for the reanimation of wrist and elbow flexion. The use of FFMT for the reanimation of the flaccid shoulder has not been described till now.

Methods: In a group of 192 patients that underwent various secondary reanimation surgeries for brachial plexus injuries, 139 patients received FFMT for elbow flexion (n=51), wrist and finger flexion (n=46) and shoulder reanimation (n= 42). The latter patient cohort of 42 patients is reported here. Patients with flaccid shoulders can be further classified into two categories, viz., (Group A) circumflex axillary nerve (CAN) lesion only (n=11) and (Group B) CAN lesion combined with suprascapular nerve (SSN) lesion (n=31). All patients underwent the same surgical procedure: transplantation of a free vascularised and innervated muscle for the reanimation of arm abduction. Innervation of the FFMT- flap was through the end branch of the accessory nerve. Revascularization was through the thoraco acromial vessels.

Results: Visible and voluntary reinnervation of the FFMT-flap occurred at 3–5 months after surgery. 10/11 patients in Group A were able to stabilize their shoulders voluntarily using the FFMT neo-deltoid muscle. 8/11 patients could abduct the arm against gravity (6/11 against resistance) to 90° according to the Neutral-Null-Scale. In Group B, the results were less encouraging. Although all patients achieved good to satisfactory stability of the shoulder and freedom from pain, none was capable of abducting the net weight of the arm using the neo-deltoid muscle alone.

Conclusions: (1) We have described the FFMT option for shoulder reanimation

(2) FFMT of the shoulder functions well only when supported by intact muscles of the neighbourhood (e.g., pectoralis major, supra- and infraspinati muscles)

(3) FFMT as a stand alone procedure in combined CAN and SSN (which is more often the case) can offer only a stabilizing effect on the shoulder and relief from instability pain.