gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

The role of free vascularized and innervated muscle Transfer in Functional Reconstruction after irreparable brachial plexus lesions

Die Rolle des frei vaskularisierten und innervierten Muskeltransfers in der funktionellen Rekonstruktion nach irreparablen Plexus-brachialis-Läsionen

Meeting Abstract

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  • corresponding author Kartik G. Krishnan - Department of Neurological Surgery, Carl Gustav Carus University Hospital, Fetscherstrasse 74, 01307 Dresden
  • T. Pinzer - Department of Neurological Surgery, Carl Gustav Carus University Hospital, Fetscherstrasse 74, 01307 Dresden
  • G. Schackert - Department of Neurological Surgery, Carl Gustav Carus University Hospital, Fetscherstrasse 74, 01307 Dresden

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.05.10

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0200.shtml

Published: April 23, 2004

© 2004 Krishnan et al.
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Outline

Text

Objective

After severe brachial plexus injuries, certain neural elements always remain irreparable. Free vascularized and innervated muscle transfer (FIMT) 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 FIMT. Thirteen patients (all males; 12 – 62 years) underwent transfer of gracilis for UE reanimation (Type I – 7 patients; Type II – 3 patients; Type III – 3 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 2 years (8 months to 4 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 FIMT.

Conclusions

FIMT 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 FIMT. Regardless of these pitfalls, FIMT is one of the possible methods of achieving function in a flail UE.