Article
Hand reanimation: Free functional gracilis versus transfer of the biceps to the long flexors of digits and the flexor pollicis longus
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Authors
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Raquel Bernardelli Iamaguchi
- University of Sao Paulo, Sao Paulo, Brazil
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Gustavo Bersani Da Silva
- University of Sao Paulo, Sao Paulo, Brazil
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Alvaro Baik Cho
- University of Sao Paulo, Sao Paulo, Brazil
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Teng Hsiang Wei
- University of Sao Paulo, Sao Paulo, Brazil
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Rames Mattar Jr
- University of Sao Paulo, Sao Paulo, Brazil
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Hand reanimation of the hand is still a challenge and in most cases of upper limb paralysis is the last treatment of reconstruction cascade. The objective of this study is to describe cases of patients without hand function and to compare functional results of cases of free functional gracilis transfer and cases of transfer of the recovered bíceps to the long flexors of digits and the flexor pollicis longus
Methods: Results were evaluated and described with both techniques
Results and Conclusions:
Case 1: male, 41 years, electric shock injury, SCIP flap for wrist contracture. Submitted to functional free gracilis for fingers flexors with neurotization with motor branch of the pronator teres.
Case 2: male, 38 years, total brachial plexus palsy. Submitted to free gracilis for elbow flexion and free gracilis for fingers flexors with intercostal nerve.
Case 3: male, 17 year, total brachial plexus palsy with absence of hand function recovery. Submitted to free gracilis for finger flexors.
Case 4: female, 32 years total brachial palsy. Submitted to a lower trapezius transfer for external rotation. Transfer of the biceps to finger flexors with fascia lata graft.
Case 5: male, 38 years with total traumatic brachial plexus injuryy, submitted to shoulder arthrodesis and latter to biceps for fingers flexors with semitendinosus graft.
Case 6: female, 24 years patient with forearm avulsion work-related accident. Macro-replantation was performed and an Anterolateral thigh flap for skin necrosis. Submitted to biceps transfer for hand reanimation.
The difficulty of resuscitation of the hand are known and still without definitive algorithm for treatment of these serious lesions. Initially, neurological reconstruction with nerve graft should be attempted when possible. In late cases, we perform functional free muscle transfers for hand reanimation when muscle transfers are not possible. However, the free transfer of functional muscle is a highly complex surgery with variable results in these cases hand reanimation. In 2009 Oberlin et al and Goubier and Teboul described the transfer of biceps for finger flexors. Similar results were obtained in our patients with both techniques, with fingers flexion for bimanual activities.
We consider the transfer of biceps for long finger flexors and flexor pollicis longus, a viable alternative for the treatment of patients without hand function, with reduced technical difficulties and surgical team when compared with free functional gracilis.
