scholarly journals Single incision thenar muscle reconstruction using the free functional pronator quadratus flap

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Martin Aman ◽  
Arne H. Boecker ◽  
Mirjam Thielen ◽  
Camillo T. Mueller ◽  
Amir K. Bigdeli ◽  
...  
Keyword(s):  
Grip Strength ◽  
Single Incision ◽  
Hand Function ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Viable Alternative ◽  
Thenar Muscle ◽  
Pronator Quadratus ◽  
Tendon Transfers ◽  
Single Incision Surgery

Abstract Background Injuries to the thenar muscle mass or the thenar branch of the median nerve and resulting loss of thumb opposition lead to a massive impairment of hand function. For decades, reconstructive approaches were based on tendon transfers. To broaden the reconstructive repertoire, we present the free functional pronator quadratus flap as a viable alternative for functional reconstruction and provide a specification for its indication. We demonstrate our surgical technique to a single incision reconstruction using the free functional pronator quadratus flap. Based on a series of three patients, which were analyzed for hand function using Kapandji’s score and the angle of Bourrel, grip strength and nerve conduction velocity in a two year follow up, we present an indication algorithm. Results After successful reinnervation of all flaps, we found an improvement of Kapandji’s score from 4.3 ± 0.94 preoperatively, to 8.7 ± 0.47 after two years. Accordingly, the angle of Bourrel decreased from 75.75 ± 3.45 degrees to 36.96 ± 3.68 degree. Grip strength also improved from 14 ± 2.2 kg to 26.2 ± 1.2 kg. No impairment of wrist pronation was observed. Conclusion We found excellent functional recovery of thumb opposition and strength, showing similar or even superior results compared to results from tendon transfers. With the benefit of a single incision surgery and therefore minimal donor site morbidity, this free functional muscle transfer is a viable alternative to classic tendon transfers.

scholarly journals Single Incision Thenar Muscle Reconstruction Using the Free Functional Pronator Quadratus Flap

2021 ◽  
Author(s):  
Martin Aman ◽  
Arne H. Boecker ◽  
Mirjam Thielen ◽  
Camillo T. Mueller ◽  
Amir K. Bigdeli ◽  
...  
Keyword(s):  
Grip Strength ◽  
Single Incision ◽  
Hand Function ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Viable Alternative ◽  
Thenar Muscle ◽  
Pronator Quadratus ◽  
Tendon Transfers ◽  
Single Incision Surgery

Abstract Background:Injuries to the thenar muscle mass or the thenar branch of the median nerve and resulting loss of thumb opposition lead to a massive impairment of hand function. For decades, reconstructive approaches were based on tendon transfers. To broaden the reconstructive repertoire, we present the free functional pronator quadratus flap as a viable alternative for functional reconstruction and provide a specification for its indication.We demonstrate our surgical technique to a single incision reconstruction using the free functional pronator quadratus flap. Based on a series of three patients, which were analyzed for hand function using Kapandji’s score and the angle of Bourrel, grip strength and nerve conduction velocity in a two year follow up, we present an indication algorithm.Results:After successful reinnervation of all flaps, we found an improvement of Kapandji’s score from 4.3 ± 0.94 preoperatively, to 8.7 ± 0.47 after two years. Accordingly, the angle of Bourrel decreased from 75.75 ± 3.45 degrees to 36.96 ± 3.68 degree. Grip strength also improved from 14 ± 2.2 kg to 26.2 ± 1.2 kg. No impairment of wrist pronation was observed.Conclusion:We found excellent functional recovery of thumb opposition and strength, showing similar or even superior results compared to results from tendon transfers. With the benefit of a single incision surgery and therefore minimal donor site morbidity, this free functional muscle transfer is a viable alternative to classic tendon transfers.

Surgical Technique and Outcomes of Reconstruction for Blauth Type III Thumb Hypoplasia

Hand ◽  
2021 ◽  
pp. 155894472110387
Author(s):  
Morad Chughtai ◽  
Kara McConaghy ◽  
Xem Bui ◽  
Grzegorz J. Kwiecien ◽  
William H. Seitz
Keyword(s):  
Hand Function ◽  
Functional Limitations ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Reconstruction Procedure ◽  
Type Iii ◽  
Cultural Preferences ◽  
Surgical Options ◽  
Hypoplastic Thumb ◽  
Postoperative Improvement

Background Historically, amputation and pollicization has been the recommended surgical treatment for Blauth type III hypoplastic thumbs. However, due to aesthetic objections or cultural preferences, some parents seek out alternative surgical options. The present study describes a nontraditional technique that preserves and augments the hypoplastic thumb. Methods Patient charts were retrospectively reviewed to identify patients with Blauth type III hypoplastic thumbs who underwent thumb reconstruction at our institution from 2008 to 2018. The reconstruction procedure involved toe phalanx transfer, staged tendon transfers, and lengthening as needed. Motion was assessed categorically as ability to flex, extend, or oppose the thumb. Functionality was assessed as ability to pinch and grasp with the surgical hand. Patient- or parent-reported improvement in thumb function was also recorded. Results Of the 13 patients, 100% could flex, extend, and oppose the thumb to some degree. Eleven patients (85%) had functional one-handed grasp, and 9 (69%) had a functional pinch. Eleven patients (85%) reported no functional limitations of the operative hand. Thirteen patients (100%) reported improvement in hand function after surgery as compared to pre-operatively. There were 2 minor complications (15%), both of which resolved after intervention. No patients experienced donor-site morbidity. Conclusions Reconstruction of Blauth III thumbs is a nontraditional technique that allows for digit retention by salvaging the hypoplastic thumb. In the present study, the majority of patients had functional thumbs and all reported postoperative improvement. Overall, our results suggest that reconstruction is a viable surgical option for Blauth III hypoplastic thumbs.

Type IIIB and IV hypoplastic thumb reconstruction with non-vascularized fourth metatarsal

2020 ◽  
Vol 45 (7) ◽  
pp. 722-728 ◽  
Author(s):  
Bo Liu ◽  
Shanlin Chen ◽  
Esther Ching San Chow ◽  
Pengcheng Li ◽  
Kun Liu ◽  
...  
Keyword(s):  
Hand Function ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Pinch Strength ◽  
Reconstruction Method ◽  
Level Of Evidence ◽  
Type Iv ◽  
Type Iiib ◽  
Rotational Flap ◽  
Staged Reconstruction

We treated 16 patients with 17 hypoplastic thumbs (eight Type IIIB and nine Type IV) using a non-vascularized fourth metatarsal transfer with a rotational flap and multi-staged reconstruction. The average age at the first operation was 24 months. The average follow-up time was 46 months. All patients achieved reasonable hand function and were able to use the reconstructed thumb to grip small and large objects. The operated thumb achieved an average Kapandji score of 6.7 and average pinch strength of 0.9 kg. There were two cases of graft nonunion. All parents are satisfied with the function and appearance of the reconstructed thumb and donor foot. We conclude that non-vascularized fourth metatarsal transfer is a feasible reconstruction method for patients with Types IIIB and IV hypoplastic thumbs. The reconstruction allows for the preservation of a 5-digit hand with reasonable function and appearance and minimal donor site morbidity, although long-term growth of the metatarsals still need to be monitored. Level of evidence: IV

The Use of Thick Split Thickness Grafts from the Instep in Paediatric Hand Surgery

1985 ◽  
Vol 10 (2) ◽  
pp. 185-189
Author(s):  
CHRISTOPHER WARD ◽  
JENNIFER ECCLESTONE
Keyword(s):  
Clinical Study ◽  
Hand Function ◽  
Donor Site ◽  
Skin Grafting ◽  
Hand Surgery ◽  
Donor Site Morbidity ◽  
No Donor ◽  
Recipient Site ◽  
Aesthetic Result ◽  
Good Aesthetic Result

In skin grafting the hand restoration of function must always be the priority, but an acceptable appearance is also important and care should be taken in selecting a skin graft that matches the recipient site. The disadvantages of some traditional donor sites are outlined. A clinical study of thick, split-thickness grafts from the instep is described from which it is concluded that a good aesthetic result can be achieved without compromising hand function—but only in children and adolescents among whom there was no donor site morbidity.

scholarly journals Investigation Into the Optimal Number of Intercostal Nerve Transfers for Musculocutaneous Nerve Reinnervation: A Systematic Review

Hand ◽  
2017 ◽  
Vol 13 (6) ◽  
pp. 621-626 ◽  
Author(s):  
Hyuma A. Leland ◽  
Beina Azadgoli ◽  
Daniel J. Gould ◽  
Mitchel Seruya
Keyword(s):  
Systematic Review ◽  
Brachial Plexus ◽  
Donor Site ◽  
Elbow Flexion ◽  
Donor Site Morbidity ◽  
Intercostal Nerve ◽  
Optimal Number ◽  
Musculocutaneous Nerve ◽  
Nerve Transfers ◽  
Meta Analyses

Background: The purpose of this study was to systematically review outcomes following intercostal nerve (ICN) transfer for restoration of elbow flexion, with a focus on identifying the optimal number of nerve transfers. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify studies describing ICN transfers to the musculocutaneous nerve (MCN) for traumatic brachial plexus injuries in patients 16 years or older. Demographics were recorded, including age, time to operation, and level of brachial plexus injury. Muscle strength was scored based upon the British Medical Research Council scale. Results: Twelve studies met inclusion criteria for a total of 196 patients. Either 2 (n = 113), 3 (n = 69), or 4 (n = 11) ICNs were transferred to the MCN in each patient. The groups were similar with regard to patient demographics. Elbow flexion ≥M3 was achieved in 71.3% (95% confidence interval [CI], 61.1%-79.7%) of patients with 2 ICNs, 67.7% (95% CI, 55.3%-78.0%) of patients with 3 ICNs, and 77.0% (95% CI, 44.9%-93.2%) of patients with 4 ICNs ( P = .79). Elbow flexion ≥M4 was achieved in 51.1% (95% CI, 37.4%-64.6%) of patients with 2 ICNs, 42.1% (95% CI, 29.5%-55.9%) of patients with 3 ICNs, and 48.4% (95% CI, 19.2%-78.8%) of patients with 4 ICNs ( P = .66). Conclusions: Previous reports have described 2.5 times increased morbidity with each additional ICN harvest. Based on the equivalent strength of elbow flexion irrespective of the number of nerves transferred, 2 ICNs are recommended to the MCN to avoid further donor-site morbidity.

Clinical evaluation of a wrist sensorimotor rehabilitation program for triangular fibrocartilage complex injuries

Hand Therapy ◽  
2021 ◽  
pp. 175899832110333
Author(s):  
Zhiqing Chen
Keyword(s):  
Grip Strength ◽  
Outcome Measures ◽  
Rating Scale ◽  
Weight Bearing ◽  
Rehabilitation Program ◽  
Triangular Fibrocartilage Complex ◽  
Effect Sizes ◽  
Pronator Quadratus ◽  
Triangular Fibrocartilage ◽  
Wrist Function

Introduction Triangular fibrocartilage complex (TFCC) injuries are associated with distal radioulnar joint (DRUJ) instability and impaired wrist proprioception. Sensorimotor training of extensor carpi ulnaris (ECU) and pronator quadratus (PQ) can enhance DRUJ stability. With limited evidence on effectiveness of TFCC sensorimotor rehabilitation, this study aimed to evaluate the effects and feasibility of a novel wrist sensorimotor rehabilitation program (WSRP) for TFCC injuries. Methods Patients diagnosed with TFCC injuries were recruited from May 2018 to January 2020 at an outpatient hand clinic in Singapore General Hospital. There are four stages in WSRP: (1) pain control, (2) muscle re-education and joint awareness, (3) neuromuscular rehabilitation, and (4) movement normalization and function. WSRP also incorporated dart throwing motion and proprioceptive neuromuscular facilitation. Outcome measures included grip strength measured with grip dynamometer, numerical pain rating scale, joint position sense (JPS) measurement, weight bearing measured with the ‘push-off’ test, and wrist function reported on the Patient Rated Wrist Hand Evaluation. Results Ten patients completed the WSRP. Mean changes were compared with minimal clinically important differences (MCID) for outcomes. All patients achieved MCID on pain, 70% of patients achieved MCID on grip strength, weight bearing and wrist function. Paired t-tests and Cohen’s D for outcome measures were calculated. There were large effect sizes of 2.47, 1.35, and 2.81 for function, grip strength and pain respectively, and moderate effect sizes of 0.72 and 0.39 for axial loading and JPS respectively. Discussion WSRP presents a potential treatment approach in TFCC rehabilitation. There is a need for future prospective clinical trials with control groups.

scholarly journals Use of Gracile and semi-tendinosus tendons (GRAST) for the reconstruction of irreparable rotator cuff tears

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marie Protais ◽  
Maxime Laurent-Perrot ◽  
Mickaël Artuso ◽  
M. Christian Moody ◽  
Alain Sautet ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Donor Site ◽  
Anatomical Study ◽  
Donor Site Morbidity ◽  
Rotator Cuff Tears ◽  
Subacromial Space ◽  
Greater Tuberosity ◽  
Working Zone ◽  
Superior Capsular Reconstruction

Abstract Background Irreparable rotator cuff tears are common and difficult to treat. Techniques for “filling the loss of substance” require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula. Methods This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SS) and upper infraspinatus (IS) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed. We proceeded to the same technique under arthroscopy for a 73 years old patient whom we treated for a painful shoulder with irreparable cuff tear. We inserted a GRAST graft using arthroscopy. Results The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases. Conclusion This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial “spacer” effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.

scholarly journals Suprafascial Free Flaps: Classification and Comprehensive Review of the Literature

2021 ◽  
Vol 6 ◽  
pp. 247275122110205
Author(s):  
Sebastian Rios ◽  
María Isabel Falguera-Uceda ◽  
Alicia Dean ◽  
Susana Heredero
Keyword(s):  
Survival Rate ◽  
Preoperative Planning ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Anterolateral Thigh Flap ◽  
Cochrane Library ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Search Terms

Study Design: Suprafascial free flaps have become common place in reconstructive surgery units. Nomenclature related to these flaps has not been uniform throughout the scientific literature, especially in regard to planes of dissection. This study is designed as a comprehensive review of the literature. Objectives: Our study highlights which flaps are used most frequently, their main indications, their survival rate, and how they have evolved in the last few decades as innovations have been introduced. Methods: A review of the literature was performed using keywords and Medical Subject Headings search terms. PubMed, Embase, and Cochrane Library were searched using the appropriate search terms. Data collected from each study included flap type, dissection plane, preoperative planning, area of reconstruction, as well as complications, donor-site morbidity and survival rate. Results: Seven hundred and fifty-five studies were found based on the search criteria. After full-text screening for inclusion and exclusion criteria 34 studies were included. A total of 1332 patients were comprised in these studies. The most common types of flaps used were superficial circumflex iliac perforator flap (SCIP), anterolateral thigh flap (ALT), and radial forearm flap. The most common areas of reconstruction were head & neck and limbs. There was no significant difference in survival rates between flaps that were raised in different planes of dissection. Conclusions: Based on the author’s review of the literature, suprafascial flaps are reliable, they have low donor site morbidity, and there is a wide selection available for harvest. The use of new technologies for preoperative planning, such as CT-Angiography and UHF ultrasound, have contributed to have more predictable results. We propose a standardized classification for these flaps, in order to create a uniform nomenclature for future reference.

A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization: An orthosis that promotes function and improvement in patients with the first carpometacarpal joint osteoarthritis

2013 ◽  
Vol 38 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Monireh Ahmadi Bani ◽  
Mokhtar Arazpour ◽  
Stephen William Hutchins ◽  
Fereydoun Layeghi ◽  
Mahmood Bahramizadeh ◽  
...  
Keyword(s):  
Grip Strength ◽  
Clinical Relevance ◽  
Hand Function ◽  
Pinch Strength ◽  
Conservative Approach ◽  
Carpometacarpal Joint ◽  
Custom Made ◽  
First Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Improved Function

Background and aim: Patients with mild to moderate first carpometacarpal joint osteoarthritis report pain, a reduction in pinch and grip strength and hand function. The purpose of this study was to analyze the effect of a custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization on pain, function, grip strength, and key pinch in these patients. Technique: A total of 11 volunteer patients participated in this study. All the above-mentioned parameters were evaluated at baseline and also 30, 60, and 90 days after using the splint. Discussion: A decrease in pain was observed after 30 days, and this continued to improve during treatment with the splint. After 90 days of using the splint, grip strength was improved. Function and pinch strength also increased significantly and was maintained during the study period compared to baseline. Clinical relevance A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization may be a suitable conservative approach for the treatment of first carpometacarpal joint osteoarthritis.

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