An investigation on the feasibility of neurotization of posterior division of median nerve with brachialis branch of musculocutaneous nerve: Cadaver study

Amaç: Travmatik brakiyal pleksus lezyonlarında el fonksiyonlarının tedaviye rağmen elde edilememesi önemli sosyoekonomik sorunlara yol açmaktadır. Medyan sinirin muskülokütan sinirin brakiyalise giden dalıyla nörotizasyonu son zamanlarda popülerlik kazanmış bir onarım yöntemidir. Bu yöntemin parmak fleksörlerine brakiyalis kasının transferine üstün olup olmadığı netlik kazanmamıştır. İnsan kadavralarında yürüttüğümüz çalışmamız transferi önerilen sinirlerde yapılacak ölçümlerle bu yöntemin olanaklılığını araştırmayı hedeflemektedir. Hastalar ve Yöntemler: Beş taze kadavra (4 erkek, 1 kadın; ort. yaş 46.3) üzerinde 10 üst ekstremite diseke edilmiş ve ilgili sinirler üzerinde ölçüm yapılmıştır. Bulgular: Medyan sinirin muskülokütan sinirin brakiyalise giden dalıyla nörotizasyonu her olguda olanaklı olamamaktadır. Bunun nedeni medyan sinirin posterior fasiküler grubu ve brakiyalis dalı arasındaki çap uyumsuzluğu ve aralarında direkt koaptasyona izin vermeyecek uzaklık olarak görülmektedir. Sonuç: Anatomik yapıda toplumlar arası farklılıklara bağlı olduğu düşünülen varyasyonlar medyan sinirin muskülokütan sinirin brakiyalis dalı ile nörotizasyonunun genel uygulanabilirliğini azaltmaktadır.Objectives: The problems encountered during recovery of traumatic brachial plexus injuries despite adequate treatment has important socioeconomic impacts. Neurotization of median nerve with brachialis muscle branch of musculocutaneous nerve has become popular recently. Whether it is superior to transfer of brachialis muscle to finger flexors is still unclear. Our research on human cadavers is aimed at examining the possibility of this nerve transfer by quantitatively describing the courses of related nerves. Patients and Methods: Ten upper extremities of 5 fresh cadavers (4 males, 1 female; mean age 46.3 years) were dissected and measurements were made on related nerves. Results: The neurotization of median nerve with brachialis muscle branch of musculocutaneous nerve is not possible in every case due to the distance between posterior fascicular group of median nerve and the brachialis branch, and the size discrepancy between these two nerves. Conclusion: Frequent variations of the anatomic structure originating from interracial differences decrease the applicability of the neurotization of median nerve with brachialis muscle branch of musculocutaneous nerve

Management Of First Web Space Contractures With Bilobed Flaps

Amaç: Birinci parmak aralığı (web) bölgesi el işlevleri açısından büyük önem taşır. Bu bölgedeki kontraktürlerin giderilmesi için en sık kullanılan yöntemlerden biri işaret parmağı dorsalinden çevrilen transpozisyon flebidir. Bu çalışmada, dorsoradyal rotasyon flebinin verici alanında ortaya çıkan kontür deformitesini gidermek ve flebin transpozisyonunu kolaylaştırmak için kullandığımız bilobe flep yöntemine ait sonuçları ortaya koymayı amaçladık. Gereç ve Yöntem: Bu yöntem kullanılarak birinci parmak aralığı kontraktürü açılmış sekiz hastaya ait tedavi ve takip bilgileri retrospektif olarak incelendi. Bulgular: Bu yöntemin uygulandığı sekiz hastalık (toplam on el) serimizde ortalama takip süresi 15,3 aydı. Olguların takiplerinde önemli bir komplikasyon görülmedi ve yeterli birinci parmak aralığı açıklığı elde edilebildi. Sonuç: Dorsoradyal transpozisyon flebinin bilobe olarak modifiye edilmesi bu fleple ilgili verici saha sorunlarını güvenli bir biçimde azaltmakta ve flebin daha rahat transpoze edilmesine olanak vermektedir.Objective: First web space is very important for overall hand function. One of the methods frequently utilized to manage contractures in this area are skin transposition flaps harvested from dorsal radial aspect of the index finger. In this study, we present our results with bilobed flap modification of the dorsoradial transposition flap we designed to facilitate the transposition of the flap and to minimize the contour deformity at the donor site. Materials and Methods: A retrospective chart review was made to gather information on eight cases operated using this modification Results: Satisfactory results were achieved and no serious complications were observed in our series consisting of eight patients (10 hands in total) with an average follow-up of 15.3 months. Conclusion: Modification of dorsoradial transposition flap in a bilobed fashion safely minimizes problems related to donor site and at the same time facilitates transposition of the fla

Surgical Restoration of Pediatric Forearm Supination Deformity in Obstetric Brachial Plexus Palsy

Purpose: Obstetrical palsy of the upper extremity repre-sents a severe traumatic complication, which involves thebrachial plexus and occasionally the osteoarticular struc-tures and muscles of the shoulder. Our aim is to describeand find an adequate modality of treatment for the rela-tively frequent obstetrical palsy sequela presented as fore-arm supination deformity. Forearm supination deformitytends to be progressive and therefore early recognition ofthis deformity is of paramount importance to prevent fixeddeformities, which increase the hand function deficit.Forearm supination deformity is classified in two stages:flexible (posture in supination) and fixed (contracture)deformity, which directly determine the choice of the oper-ative procedure(s). When passive reduction of the supina-tion deformity is possible (flexible deformity) soft tissueprocedures including tendon transfers are indicated. Thebony procedures should be preferred in cases with severecontracture of the forearm in supination and distal radio-ulnar joint luxation (fixed deformity). In this study we usedsoft tissue techniques (including biceps re-routingpronotoplasty, brachioradialis re-routing pronotoplastywith or without interosseous membrane release) and tech-niques which include osteotomy of the forearm bones (ex-cision of the radial head, radius pronation osteotomy, distalradio-ulnar fusion and wrist arthrodesis) to restore fore-arm posture and wrist stability in patients with supinationdeformity secondary to brachial plexus birth palsy.Methods: Forty-three children (27 male, 16 female) whoseage ranged between 3 and 15 years (mean age 8.2) oper-ated between 1998 and 2004 were included in this study.Eighteen of them (11 male, 7 female) underwent soft tissueprocedures, while twenty-five (16 male, 9 female) hadosteotomy.Results: As soft tissue procedures, the selected tech-niques were biceps re-routing pronotoplasty for 4 children and brachioradialis re-routing pronotoplasty for 14 ofthem. Average gain in active pronation was 82.5 degrees,average loss of active supination was 22.5 degrees andaverage gain in total active motion was 55 degrees forthe biceps re-routing group, whereas average gain inactive pronation was 63.5 degrees, average loss of activesupination was 11 degrees and average gain in total activemotion was 53.2 degrees in brachioradialis re-routinggroup. Selected techniques were excision of the radialhead for 4 patients, radius pronation osteotomy for 6patients, distal radio-ulnar fusion for 4 patients and wristarthrodesis for 4 patients as the osteotomy procedures.Average gain in active pronation was 96 degrees in radiushead excision, 66 degrees in radius pronation osteotomy,61 degrees in distal radio-ulnar fusion and 58 degrees inwrist arthrodesis groups. For the osteotomy group as awhole, the mean active forearm supination decreasedfrom 50.4 degrees preoperatively to 40.8 degrees after sur-gery. More than one procedure (mostly 2-3) were oftennecessary to achive the desired results.Conclusions: These results clearly show that patients canbenefit from surgical correction of forearm supinationdeformity which probably will cause significant improve-ment in functional status. After these surgical procedures,in a considerable proportion of patients, the "begging hand"posture can be corrected to a more functional and lessnoticeable position. Key words: Obstetric palsy, brachialplexus, supination deformity, osteotomy, brachioradialisre-routing pronotoplasty

Temporomandibuler eklem ınternal bozukluklarının tedavisinde yeni bir düşünce: Hücre ekimi yoluyla disk onarımı

Yaygın görülen bir temporomandibuler eklem (TME) rahatsızlığı olan internal bozukluk (IB), TME diskinin yerdeğiştirmesi ve disfonksiyonudur. ID için pek çok tedavi modalitesi önerilmiştir. Hipotezimize göre geç dönem ID hastalarında intraartiküler disk içine adipozal mezenşimal ve kostakondral dokulardan elde edilen kök hücre ve kondrositlerle ekim yapılabilir. Ekim artroskopik lavaj ve adhesiyektomiyi takiben uygulanabilir. Bildiğimiz kadarıyla invivo şartlarda disk mühendisliği konusunda yapılan çalışma yoktur. Bu nedenle invivo hücre-matriks etkileşimini içeren bu yeni tedavi yöntemini öneriyoruz.Internal derangement (ID) is the displacement and dysfunction of temporomandibular joint (TMJ) disc and is commonly seen TMJ disorder. Many treatment modalities developed for ID. We hypothesize that stem cells and chondrocytes harvested from adiposal mesenchymal and costachondral tissues can be seeded inside the intraarticular disc in late stages ID patients. This can be done after arthroscopic lavage and adhesiectomy. To our best notice, there are no studies about disc engineering invivo conditions. Therefore, we offer new therapy which include cellmatrix interactions invivo

Brachialis muscle transfer to the forearm for the treatment of deformities in spastic cerebral palsy

The use of the brachialis muscle for tendon transfers in cerebral palsy has not been described previously. In this study, the brachialis muscle was used for transfer in 11 patients with spastic cerebral palsy for the restoration of forearm supination, wrist extension, or finger extension