Current Procedure of Double Free Muscle Transfer for Traumatic Total Brachial Plexus Palsy by Kazuteru Doi, Yasunori Hattori, Sotetsu Sakamoto, Chaitanya.

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Presentation transcript:

Current Procedure of Double Free Muscle Transfer for Traumatic Total Brachial Plexus Palsy by Kazuteru Doi, Yasunori Hattori, Sotetsu Sakamoto, Chaitanya Dodakundi, Nilesh G. Satbhai, and Tristram Montales JBJS Essent Surg Tech Volume 3(3):e16 July 10, 2013 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Figs. 1-A and 1-B MRIs of a patient with brachial plexus palsy. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Transverse view of the C5 nerve root showing no anterior rootlet on the right side (arrow). Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Free vascularized nerve graft (FVNG) between the C5 nerve root and the suprascapular nerve (SSN) and upper trunk following anastomoses of the nutrient vessels to the transverse cervical artery and vein (a.v.). Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Vascularized ulnar nerve graft (VUNG) between the contralateral C7 nerve root and the suprascapular nerve (SSN), posterior cord (PC), and long thoracic nerve (LT) following anastomoses of the nutrient vessels (a.v.) to the transverse cervical artery and vein. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Marking of the skin incision on the contralateral thigh for harvesting of the gracilis muscle graft. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

The harvested gracilis muscle. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Stage II of the procedure, in which the first gracilis muscle graft is used to restore elbow flexion and finger extension. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Stage III of the procedure: sensory restoration of the hand with nerve transfer of the intercostobrachial nerve and sensory rami of the second and third intercostal nerves to the median nerve and reconstruction of elbow extension with nerve transfer of the... Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Stage III of the procedure, in which the second gracilis muscle graft is used to restore elbow flexion and finger flexion. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Early passive mobilization of the muscle-tendon graft by manual movement of the finger and wrist joints. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Early passive mobilization of the muscle-tendon graft by manual movement of the finger and wrist joints. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Wrist fusion with a dynamic compression plate and screws. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Capsulodesis of the metacarpophalangeal joint for static correction of claw finger deformity, by proximal advancement of the distally based flap of the volar plate. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Figs. 8-A through 8-E Illustrative case. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Elbow flexion. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Elbow extension. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Finger flexion. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Finger extension. Kazuteru Doi et al. JBJS Essent Surg Tech 2013;3:e16 ©2013 by The Journal of Bone and Joint Surgery, Inc.